Broderick Chiropractic Center

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

08000723A Issued in IN

Legal business name

BRODERICK CHIROPRACTIC CENTER

Practice address

1424 Johnson St
Elkhart, IN 46514-3404

Phone

(574) 264-4151

Fax

(574) 262-9891

NPI assigned

Oct 15, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Susan A Broderick

Title

Office Manager

Phone

(574) 264-4151

Specialties & licenses 2

Addresses

Other identifiers 4

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jerald R Broderick, D.C.

  • Chiropractor
  • Elkhart, IN
  • NPI 1518923945
  NPD (past)
• Ian Stone, D.C

  • Chiropractor
  • Fishers, IN
  • NPI 1679949812
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413331200000",
    "number": "1184028490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1424 JOHNSON ST",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465143404",
            "telephone_number": "574-264-4151",
            "fax_number": "574-262-9891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1424 JOHNSON ST",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465143404",
            "telephone_number": "574-264-4151",
            "fax_number": "574-262-9891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRODERICK CHIROPRACTIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-15",
        "last_updated": "2014-10-15",
        "status": "A",
        "authorized_official_last_name": "BRODERICK",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "574-264-4151"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IN",
            "license": "08000723A",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IN",
            "license": "08000306A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100112520A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100203690A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000000084724",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000000112128",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven D Bright, LCSW
• Julianna Briseno
• Bristol Street Pediatrics, P.C.
• David Roger Britzke, O.D.
• Jaida Brock
• Jerald R Broderick, D.C.
• Glen H Brookshire, DO
• Renee Brookshire, CRNA
• Amanda Broskey
• Tosheta Brown-Greenfield, PMHNP

• Chiropractor in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Chiropractor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.