Provider Demographics
NPI:1821098336
Name:BROPHY, DONALD RICHARD III (DC,)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:RICHARD
Last Name:BROPHY
Suffix:III
Gender:M
Credentials:DC,
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:
Other - Last Name:BROPHY
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3731 SUNSET LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6127
Mailing Address - Country:US
Mailing Address - Phone:925-754-6780
Mailing Address - Fax:925-754-6915
Practice Address - Street 1:3731 SUNSET LN
Practice Address - Street 2:SUITE 102
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6127
Practice Address - Country:US
Practice Address - Phone:925-754-6780
Practice Address - Fax:925-754-6915
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15826111NI0900X, 111NX0100X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0158260Medicaid
CAT76484OtherHILL PHYSICIANS
CAT76484OtherHILL PHYSICIANS