Provider Demographics
NPI:1942298260
Name:BRODKIN, RONALD A (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:A
Last Name:BRODKIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 NW BOCA RATON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-1614
Mailing Address - Country:US
Mailing Address - Phone:561-620-0174
Mailing Address - Fax:561-620-0349
Practice Address - Street 1:7805 NW BEACON SQUARE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1395
Practice Address - Country:US
Practice Address - Phone:561-620-0174
Practice Address - Fax:561-988-2125
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4412111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380584100Medicaid
FL380584100Medicaid
FLT85458Medicare UPIN