Provider Demographics
NPI:1013953553
Name:DR SOPHIE BRODEUR LLC
Entity Type:Organization
Organization Name:DR SOPHIE BRODEUR LLC
Other - Org Name:NORWOOD CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, D.C.
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODEUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-531-2277
Mailing Address - Street 1:4226 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212
Mailing Address - Country:US
Mailing Address - Phone:513-531-2277
Mailing Address - Fax:513-531-2278
Practice Address - Street 1:4226 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212
Practice Address - Country:US
Practice Address - Phone:513-531-2277
Practice Address - Fax:513-531-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2039985Medicaid
OH1871538157Medicare UPIN
OHDR9335151Medicare ID - Type Unspecified