Jerald R Broderick, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

306 Issued in IN

Practice address

1424 Johnson St
Elkhart, IN 46514-3404

Phone

(574) 264-4151

Fax

(574) 262-9891

NPI assigned

Apr 25, 2006

Last updated

Mar 16, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Broderick Chiropractic Center

  • Chiropractor
  • Elkhart, IN
  • NPI 1184028490
  NPD (past)
• Chiropractic Health and Max Performance, LLC

  • Chiropractor
  • Noblesville, IN
  • NPI 1841676046
  NPD (past)

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268697600000",
    "number": "1518923945",
    "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": {
        "last_name": "BRODERICK",
        "first_name": "JERALD",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-25",
        "last_updated": "2010-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IN",
            "license": "306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "000000084724",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL/WC/AA",
            "identifier": "306",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100112520A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julianna Briseno
• Bristol Street Pediatrics, P.C.
• David Roger Britzke, O.D.
• Jaida Brock
• Broderick Chiropractic Center
• Glen H Brookshire, DO
• Renee Brookshire, CRNA
• Amanda Broskey
• Tosheta Brown-Greenfield, PMHNP
• Denise Christine Brown, CRNA

• 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 Mar 16, 2010; 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.