Individual provider Active NPI

Nicholas Andrew Broder, DC

  • Chiropractor
  • Howards Grove, WI
National Provider Identifier
1225929151
Registry record updated Jul 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
6324-12 Issued in WI
Practice address
516 S Wisconsin Dr
Howards Grove, WI 53083-1261
Phone
(920) 565-3922
Fax
(920) 565-2142
NPI assigned
Jul 10, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 6324-12 WI Primary

Addresses

Primary practice location

516 S Wisconsin Dr
Howards Grove, WI 53083-1261

Mailing address

N8420 State Road 57
Elkhart Lake, WI 53020-2040
Phone (920) 207-7864

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250819001606 WI Practitioner - Chiropractic 6103325915 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Varish Chiropractic Clinics LLCGroup PAC ID 4981675543, 5 clinicians

Practice addresses (Care Compare)

516 S Wisconsin Dr
Howards Grove, WI 53083-1261
Phone (920) 565-3922

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6324-12WIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Varish Chiropractic Clinics, LLC Chiropractor CurrentSince Jul 10, 2025 Accepting new patients

Locations

516 S Wisconsin Dr
Sheboygan, WI 53083
Phone (920) 565-3922

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1752105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752105600000",
    "number": "1225929151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N8420 STATE ROAD 57",
            "city": "ELKHART LAKE",
            "state": "WI",
            "postal_code": "530202040",
            "telephone_number": "920-207-7864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 S WISCONSIN DR",
            "city": "HOWARDS GROVE",
            "state": "WI",
            "postal_code": "530831261",
            "telephone_number": "920-565-3922",
            "fax_number": "920-565-2142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODER",
        "first_name": "NICHOLAS",
        "middle_name": "ANDREW",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-07-10",
        "last_updated": "2025-07-10",
        "certification_date": "2025-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "6324-12",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Howards Grove, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.