Provider Demographics
NPI:1366580375
Name:BROEG, EVA KRISTIN (DC)
Entity type:Individual
Prefix:DR
First Name:EVA
Middle Name:KRISTIN
Last Name:BROEG
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 1:2603 MYRTLE LN
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-7862
Mailing Address - Country:US
Mailing Address - Phone:859-802-5795
Mailing Address - Fax:
Practice Address - Street 1:1029 BURLINGTON PIKE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1235
Practice Address - Country:US
Practice Address - Phone:859-525-2020
Practice Address - Fax:859-525-0472
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5039111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor