Provider Demographics
NPI:1770643025
Name:BROUGHTON, DONALD O (DC)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:O
Last Name:BROUGHTON
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 1:846 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428-1438
Mailing Address - Country:US
Mailing Address - Phone:570-226-4050
Mailing Address - Fax:570-226-8217
Practice Address - Street 1:846 CHURCH ST
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-1438
Practice Address - Country:US
Practice Address - Phone:570-226-4050
Practice Address - Fax:570-226-8217
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001634L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006216200001Medicaid
PA0006216200001Medicaid
PAT28785Medicare UPIN