Jesse Broderson, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

978 Issued in HI

Practice address

74-5620 Palani Rd Ste a
Suite 102
Kailua Kona, HI 96740-3640

Phone

(808) 329-7797

Fax

(808) 329-2748

NPI assigned

Oct 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in HI

Enrollment records 1

Specialty

Chiropractic

Education

Life Chiropractic College - West, 2003

Medicare assignment

May accept Medicare assignment

Group practices

Hogan and Broderson ChiropracticGroup PAC ID 8325036643, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Hogan and Broderson Chiropractic

  dba Malama Chiropractic Clinic

  • Chiropractor
  • Kailua Kona, HI
  • NPI 1255483954
  Medicare reassignment Care Compare group NPD
• Malama Chiropractic

  • Point of Service
  • Kailua Kona, HI
  • NPI 1497995633
  NPD (past) Authorized official
• Olakino Health & Wellness LLC

  dba Olakino Health & Wellness

  • Nurse Practitioner
  • Kailua Kona, HI
  • NPI 1316722622
  NPD

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294444800000",
    "number": "1487738852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "74-5620A PALANI RD",
            "address_2": "SUITE 102",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967403100",
            "telephone_number": "808-329-7797",
            "fax_number": "808-329-2748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "74-5620 PALANI RD STE A",
            "address_2": "SUITE 102",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967403640",
            "telephone_number": "808-329-7797",
            "fax_number": "808-329-2748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERSON",
        "first_name": "JESSE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2011-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "HI",
            "license": "978",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA PIN NUMBER",
            "identifier": "244335",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cassandra Briggs
• Peggy Brisbane, LMT
• Lisa Ann Brittain, M.S.
• Anne C Broderson, APRN, FNP-C
• Jennifer Diane Broderson, L.M.T.
• Shannon Marie Broderson, D.C.
• Dennis Brody
• Sharon Brown Guillermo, LMT
• Ashlynne Brown, CNM
• Michael G, Brown, PT

• Chiropractor in Kailua Kona, HI
• Providers in Kailua Kona, HI by specialty
• Chiropractor in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2011; 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.