Healthcare Provider Details

I. General information

NPI: 1942361035
Provider Name (Legal Business Name): BRIAN JOHN BROSKOSKIE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 04/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30838 VINES CREEK RD SUITE 2 A
DAGSBORO DE
19939-4385
US

IV. Provider business mailing address

30838 VINES CREEK RD SUITE 2 A
DAGSBORO DE
19939-4385
US

V. Phone/Fax

Practice location:
  • Phone: 302-408-0000
  • Fax: 302-358-2453
Mailing address:
  • Phone: 302-404-0000
  • Fax: 302-358-2453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberF1-924
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: