Provider Demographics
NPI:1952176182
Name:BROOM CHIROPRACTIC AND SPORTS THERAPY
Entity Type:Organization
Organization Name:BROOM CHIROPRACTIC AND SPORTS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DC
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LUKE
Authorized Official - Last Name:BROOM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-314-4484
Mailing Address - Street 1:32 SPRING RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5036
Mailing Address - Country:US
Mailing Address - Phone:501-314-4484
Mailing Address - Fax:
Practice Address - Street 1:2 BECKY LN
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9200
Practice Address - Country:US
Practice Address - Phone:501-314-4484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty