Provider Demographics
NPI:1245375435
Name:BROBERG, ROBERT SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SCOTT
Last Name:BROBERG
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 1:550 S EREMLAND DR
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3100
Mailing Address - Country:US
Mailing Address - Phone:626-332-7829
Mailing Address - Fax:626-966-0235
Practice Address - Street 1:550 S EREMLAND DR
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3100
Practice Address - Country:US
Practice Address - Phone:626-332-7829
Practice Address - Fax:626-966-0235
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954528993OtherTIN
CA954528993OtherTIN
CAU16915Medicare UPIN