Provider Demographics
NPI:1942361035
Name:BROSKOSKIE, BRIAN JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOHN
Last Name:BROSKOSKIE
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 1:30838 VINES CREEK RD
Mailing Address - Street 2:SUITE 2 A
Mailing Address - City:DAGSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19939-4385
Mailing Address - Country:US
Mailing Address - Phone:302-404-0000
Mailing Address - Fax:302-358-2453
Practice Address - Street 1:30838 VINES CREEK RD
Practice Address - Street 2:SUITE 2 A
Practice Address - City:DAGSBORO
Practice Address - State:DE
Practice Address - Zip Code:19939-4385
Practice Address - Country:US
Practice Address - Phone:302-408-0000
Practice Address - Fax:302-358-2453
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-924111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU61467Medicare UPIN