Provider Demographics
NPI:1316992159
Name:BROZEK, RAYMOND WILLIAM (DC)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:WILLIAM
Last Name:BROZEK
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 1:1072 FERRY RD
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-5513
Mailing Address - Country:US
Mailing Address - Phone:215-262-1849
Mailing Address - Fax:
Practice Address - Street 1:1072 FERRY RD
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-5513
Practice Address - Country:US
Practice Address - Phone:215-262-1849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003541L111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA070985Medicare ID - Type Unspecified