Provider Demographics
NPI:1295914927
Name:BROSMER CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:BROSMER CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BROSMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-634-1977
Mailing Address - Street 1:1525 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-1622
Mailing Address - Country:US
Mailing Address - Phone:812-634-1977
Mailing Address - Fax:
Practice Address - Street 1:1525 NEWTON ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1622
Practice Address - Country:US
Practice Address - Phone:812-634-1977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001991A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000202113OtherANTHEM
IN184950Medicare PIN
IN000000202113OtherANTHEM