Provider Demographics
NPI:1194704353
Name:BROLIN, DOROTHY B (DC)
Entity type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:B
Last Name:BROLIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5704 LAKEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-6402
Mailing Address - Country:US
Mailing Address - Phone:919-622-7111
Mailing Address - Fax:919-622-7111
Practice Address - Street 1:5704 LAKEHAVEN DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-6402
Practice Address - Country:US
Practice Address - Phone:919-622-7111
Practice Address - Fax:919-622-7111
Is Sole Proprietor?:No
Enumeration Date:2006-01-15
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2454002AMedicare PIN
NC2454002Medicare PIN