Provider Demographics
NPI:1194260372
Name:BRODKIN CHIROPRACTIC AND ACUPUNCTURE
Entity type:Organization
Organization Name:BRODKIN CHIROPRACTIC AND ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRODKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC,DIBCN,DIBE,FIACN
Authorized Official - Phone:561-620-0174
Mailing Address - Street 1:7805 NW BEACON SQUARE BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1395
Mailing Address - Country:US
Mailing Address - Phone:561-620-0174
Mailing Address - Fax:561-988-2125
Practice Address - Street 1:7805 NW BEACON SQUARE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1395
Practice Address - Country:US
Practice Address - Phone:561-620-0174
Practice Address - Fax:561-988-2125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4412111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT85458Medicare UPIN