Provider Demographics
NPI:1336854538
Name:BROBERG CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:BROBERG CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MYDOUANGCHANH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-516-5916
Mailing Address - Street 1:550 S EREMLAND DR
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3100
Mailing Address - Country:US
Mailing Address - Phone:626-332-7829
Mailing Address - Fax:626-966-0235
Practice Address - Street 1:550 S EREMLAND DR
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3100
Practice Address - Country:US
Practice Address - Phone:626-332-7829
Practice Address - Fax:626-966-0235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty