Michael A Broseke, D.C.
Individual provider Active NPI Chiropractor · Kenton, OH
NPI 1972506517 · NPPES record last updated Sep 26, 2023
Key facts
- NPI
- 1972506517
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 876 (OH)
- Practice address
- 317 E Carrol St
Kenton, OH 43326-1539 - Phone
- (419) 673-1163
- Fax
- (419) 673-1163
- NPI assigned
- May 27, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 1981
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
317 E Carrol St
Kenton, OH 43326-1539
Phone (419) 673-1163
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080806000396 | OH | Practitioner - Chiropractic | 5395819585 |
Receives reassigned benefits from 1 practitioner Practice locations: Kenton, OH |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 876 | OH | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lima Memorial Joint Operating Company | Past | Accepting new patients | |
| Michael a Broseke D.C. | Chiropractor | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 876 | OH | Yes |
Addresses
Primary practice location
317 E Carrol St
Kenton, OH 43326-1539
Mailing address
317 E Carrol St
Kenton, OH 43326-1539
Phone (419) 673-1163
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 341353287-00 | Other | OH | WORKER'S COMPENSATION |
| 000000130887 | Other | OH | ANTHEM PROVIDER NUMBER |
| 0493685 | Medicaid | OH |
Other providers in Kenton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.