Healthcare Provider Details

I. General information

NPI: 1841324357
Provider Name (Legal Business Name): JACQUELINE BROUGHTON DC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 S WINCHESTER BLVD
SAN JOSE CA
95128-3909
US

IV. Provider business mailing address

1142 S WINCHESTER BLVD
SAN JOSE CA
95128-3909
US

V. Phone/Fax

Practice location:
  • Phone: 408-247-4503
  • Fax: 408-984-6304
Mailing address:
  • Phone: 408-247-4503
  • Fax: 408-984-6304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JACQUELINE E BROUGHTON
Title or Position: DIRECTOR
Credential: D.C.
Phone: 408-247-4503