Broda Chiropractic & Sports

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3157 Issued in NC

Legal business name

BRODA CHIROPRACTIC & SPORTS

Practice address

9605 Caldwell Commons Cir
Suite C
Cornelius, NC 28031-8138

Phone

(704) 987-9818

Fax

(704) 987-9718

NPI assigned

Dec 12, 2006

Last updated

Sep 4, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Michael Mark Broda, D.C.NPI 1750451712

Title

Owner

Phone

(704) 987-9818

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 1

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.

• Michael Mark Broda, D.C.

  • Chiropractor
  • Cornelius, NC
  • NPI 1750451712
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409788800000",
    "number": "1801956362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9605 CALDWELL COMMONS CIR",
            "address_2": "SUITE C",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280318138",
            "telephone_number": "704-987-9818",
            "fax_number": "704-987-9718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9605 CALDWELL COMMONS CIR",
            "address_2": "SUITE C",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280318138",
            "telephone_number": "704-987-9818",
            "fax_number": "704-987-9718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRODA CHIROPRACTIC & SPORTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2014-09-04",
        "status": "A",
        "authorized_official_last_name": "BRODA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-987-9818",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "3157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "085MJ",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tracey Renee Brake
• Bridge Plan, PLLC
• Bright Waves Counseling, PLLC
• Brightside ABA NC LLC
• Kristina Briscoe
• Michael Mark Broda, D.C.
• Aalasa Brooks
• Amber Hartman Brown, PT, DPT
• Frieda Brown, PH.D.
• Pamela Brown

• Chiropractor in Cornelius, NC
• Providers in Cornelius, NC by specialty
• Chiropractor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2014; 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.