Organization Active NPI

Broad Family Chiropractic

  • Chiropractor
  • Canton, MI
National Provider Identifier
1679781561
Registry record updated Aug 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301008122 Issued in MI
Legal business name
BROAD FAMILY CHIROPRACTIC
Practice address
43399 Joy Rd
Canton, MI 48187-2076
Phone
(734) 354-9900
Fax
(734) 354-8755
NPI assigned
May 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2009

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

Authorized official

Name
Dr. Eric Allen Broad, D.C.NPI 1629012703
Title
President
Phone
(734) 354-9900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 2301008122 MI Primary

Addresses

Primary practice location

43399 Joy Rd
Canton, MI 48187-2076

Mailing address

43423 Joy Rd
Canton, MI 48187-2053
Phone (734) 354-9900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120111000293 MI Part B Supplier - Clinic/Group Practice 3375710577 Receives reassigned benefits from 3 practitioners
Practice locations: Canton, MI

National Provider Directory

National Provider Directory

Locations

43423 Joy Rd
Canton, MI 48187
Phone (734) 354-9900

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1249862400000",
    "number": "1679781561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43423 JOY RD",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481872053",
            "telephone_number": "734-354-9900",
            "fax_number": "734-354-8755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43399 JOY RD",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481872076",
            "telephone_number": "734-354-9900",
            "fax_number": "734-354-8755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROAD FAMILY CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2009-08-10",
        "status": "A",
        "authorized_official_last_name": "BROAD",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "734-354-9900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301008122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.