Provider Demographics
NPI:1891827812
Name:BROUGHTON, JACQUELINE (DC)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 SUNSET BLVD
Mailing Address - Street 2:SUITE 170-237
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4338
Mailing Address - Country:US
Mailing Address - Phone:408-621-6194
Mailing Address - Fax:
Practice Address - Street 1:6000 FAIRWAY DR
Practice Address - Street 2:SUITE 1
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-4244
Practice Address - Country:US
Practice Address - Phone:916-259-1732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HJ620AMedicare PIN