Provider Demographics
NPI:1194804310
Name:BRODBECK, STEVEN R (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:BRODBECK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 SWEETWATER RD
Mailing Address - Street 2:SUITE S
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-7650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1727 SWEETWATER RD STE S
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7651
Practice Address - Country:US
Practice Address - Phone:619-474-0900
Practice Address - Fax:619-474-8208
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17026111NX0100X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
No111NX0100XChiropractic ProvidersChiropractorOccupational Health