Provider Demographics
NPI:1972506517
Name:BROSEKE, MICHAEL A (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:BROSEKE
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 1:317 E CARROL ST
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-1539
Mailing Address - Country:US
Mailing Address - Phone:419-673-1163
Mailing Address - Fax:419-673-1163
Practice Address - Street 1:317 E CARROL ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-1539
Practice Address - Country:US
Practice Address - Phone:419-673-1163
Practice Address - Fax:419-673-1163
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH876111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341353287-00OtherWORKER'S COMPENSATION
OH000000130887OtherANTHEM PROVIDER NUMBER
OH0493685Medicaid
OH000000130887OtherANTHEM PROVIDER NUMBER
OHT47325Medicare UPIN