Healthcare Provider Details

I. General information

NPI: 1942298260
Provider Name (Legal Business Name): RONALD A BRODKIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7805 NW BEACON SQUARE BLVD SUITE 103
BOCA RATON FL
33487-1395
US

IV. Provider business mailing address

1640 NW BOCA RATON BLVD
BOCA RATON FL
33432-1614
US

V. Phone/Fax

Practice location:
  • Phone: 561-620-0174
  • Fax: 561-988-2125
Mailing address:
  • Phone: 561-620-0174
  • Fax: 561-620-0349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberCH4412
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: