MEDICARE: DR. ERIC MARTIN BROUGHTON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4731	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CO04529	OTHER	CO	SUB ID
2	BR634129	OTHER	CO	BC/BS ID
3	C48793	OTHER	CO	PROVIDER ID

General Provider Information

NPI Number	:	1760430706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC MARTIN BROUGHTON D.C.

Provider Business Mailing Address
First Line	:	260 E HORSETOOTH RD
Second Line	:
City	:	FT COLLINS
State	:	CO
Zip	:	80525-3124
Country	:	US
Telephone Number	:	970-223-2866
Fax Number	:	970-223-2867

Provider Business Practice Location Address
First Line	:	260 E HORSETOOTH RD
Second Line	:
City	:	FT COLLINS
State	:	CO
Zip	:	80525-3124
Country	:	US
Telephone Number	:	970-223-2866
Fax Number	:	970-223-2867

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/08/2007

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