Provider Demographics
NPI:1588686778
Name:BROSMER, JARED MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:MICHAEL
Last Name:BROSMER
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 1:1525 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-1622
Mailing Address - Country:US
Mailing Address - Phone:812-634-1977
Mailing Address - Fax:812-634-1977
Practice Address - Street 1:1525 NEWTON ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1622
Practice Address - Country:US
Practice Address - Phone:812-634-1977
Practice Address - Fax:812-634-1977
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001991A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000202113OtherANTHEM
IN200433240 AMedicaid
IN184950Medicare PIN
IN200433240 AMedicaid