Russell David Broccoli, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DCP00204 Issued in RI

Practice address

635 Hope Street
Providence, RI 02906

Phone

(401) 351-6390

Fax

(401) 331-0614

NPI assigned

Nov 28, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Hope Chiropractic Centre, Inc

  • Chiropractor
  • Providence, RI
  • NPI 1154457869
  Authorized official Same address or phone

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689740607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 HOPE STREET",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "02906",
            "telephone_number": "401-351-6390",
            "fax_number": "401-331-0614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 HOPE STREET",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "02906",
            "telephone_number": "401-351-6390",
            "fax_number": "401-331-0614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCCOLI",
        "first_name": "RUSSELL",
        "middle_name": "DAVID",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "RI",
            "license": "DCP00204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHIP",
            "identifier": "204088",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "90476",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pamela M Brissette, PA-C
• Julia Britto, DNP, APRN, FNP-C
• Broadway OB GYN LLP
• Broadway Psychotherapy, Inc.
• David John Broccoli, PHARM.D.
• Sara McKenna Brockway, MASTERS
• John G. Broderick, DMD
• Michelle J Brodeur, CRNA
• Cheryl Brodsky, M.D.
• Jeffrey M Brody, MD

• Chiropractor in Providence, RI
• Providers in Providence, RI by specialty
• Chiropractor in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.