Provider Demographics
NPI:1255376299
Name:BRODAR, THOMAS STEVEN (DC, LCP)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:STEVEN
Last Name:BRODAR
Suffix:
Gender:M
Credentials:DC, LCP
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:STEVEN
Other - Last Name:BRODAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, LCP
Mailing Address - Street 1:1303 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DELPHI
Mailing Address - State:IN
Mailing Address - Zip Code:46923-8729
Mailing Address - Country:US
Mailing Address - Phone:765-564-4898
Mailing Address - Fax:765-564-2414
Practice Address - Street 1:1303 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DELPHI
Practice Address - State:IN
Practice Address - Zip Code:46923-8729
Practice Address - Country:US
Practice Address - Phone:765-564-4898
Practice Address - Fax:765-564-2414
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000733A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000084814OtherANTHEM
IN100088960Medicaid
INT 34592Medicare UPIN
IN100088960Medicaid