Provider Demographics
NPI:1851325104
Name:JAY BRODWYN CLINICARE OF COLUMBUS INC
Entity Type:Organization
Organization Name:JAY BRODWYN CLINICARE OF COLUMBUS INC
Other - Org Name:JAY BRODWYN
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:BRODWYN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-563-3370
Mailing Address - Street 1:3624 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-2184
Mailing Address - Country:US
Mailing Address - Phone:706-563-3370
Mailing Address - Fax:706-563-3501
Practice Address - Street 1:3624 EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-2184
Practice Address - Country:US
Practice Address - Phone:706-563-3370
Practice Address - Fax:706-563-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADC1811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7365Medicare PIN