Provider Demographics
NPI:1962598052
Name:BROMAN, DOUGLAS SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:SCOTT
Last Name:BROMAN
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 1:7237 FORESTVIEW LANE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-5501
Mailing Address - Country:US
Mailing Address - Phone:763-420-8595
Mailing Address - Fax:763-420-2029
Practice Address - Street 1:7237 FORESTVIEW LANE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-5501
Practice Address - Country:US
Practice Address - Phone:763-420-8595
Practice Address - Fax:763-420-2029
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN002312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350002538Medicare ID - Type Unspecified