Kenice Anne Broughman, D.C.

Primary specialty

Nutrition ChiropractorTaxonomy code 111NN1001X

License

038.005796 Issued in IL

Practice address

4555 N Lincoln Ave
Chicago, IL 60625-2102

Phone

(386) 763-2763

NPI assigned

Aug 2, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Dr. Kenice Anne Grand Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Active Wellness LLC

  • Chiropractor
  • Chicago, IL
  • NPI 1891120408
  NPD
• Active Wellness, LLC

  • Chiropractor
  • Chicago, IL
  • NPI 1902162662
  NPD
• Maitland Chiropractic Clinic Inc

  • Chiropractor
  • Maitland, FL
  • NPI 1023075181
  NPD (past)

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1215944855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4555 N LINCOLN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606252102",
            "telephone_number": "773-328-8153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4555 N LINCOLN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606252102",
            "telephone_number": "386-763-2763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUGHMAN",
        "first_name": "KENICE",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-02",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NN1001X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Nutrition",
            "state": "FL",
            "license": "CH0006374",
            "primary": false
        },
        {
            "code": "111NN1001X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Nutrition",
            "state": "IL",
            "license": "038.005796",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000872000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENICE",
            "last_name": "GRAND",
            "middle_name": "ANNE",
            "prefix": "DR.",
            "credential": "D.C.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Katherine Hyde Brott, PHD
• Colette Bridget Brottman, MMS, PA-C
• Lauren Broucek, MSN, APN, FNP-BC
• David Brouch
• Shawna Brough, PSYD
• Ashley Brouman
• Katie Cummins Brourman, MA, CCC-SLP
• Leah C Brousalis, CF-SLP
• Michael Lee Brouse
• Richard Macur Brousil, PSY.D., LPHA

• Nutrition Chiropractor in Chicago, IL
• Providers in Chicago, IL by specialty
• Nutrition Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; 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.