Healthcare Provider Details

I. General information

NPI: 1326557828
Provider Name (Legal Business Name): BRODERICK CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3816 WOODRUFF AVE STE 202
LONG BEACH CA
90808-2145
US

IV. Provider business mailing address

3816 WOODRUFF AVE STE 202
LONG BEACH CA
90808-2145
US

V. Phone/Fax

Practice location:
  • Phone: 562-420-5433
  • Fax:
Mailing address:
  • Phone: 562-420-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberDC30736
License Number StateCA

VIII. Authorized Official

Name: MRS. LINDSAY MARGRET WEBER BRODERICK
Title or Position: OWNER/PRESIDENT
Credential: DC
Phone: 562-420-5433