Healthcare Provider Details

I. General information

NPI: 1255376299
Provider Name (Legal Business Name): THOMAS STEVEN BRODAR D.C., L.C.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: THOMAS STEVEN BRODAR D.C., L.C.P.

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 S WASHINGTON ST
DELPHI IN
46923-8729
US

IV. Provider business mailing address

1303 S WASHINGTON ST
DELPHI IN
46923-8729
US

V. Phone/Fax

Practice location:
  • Phone: 765-564-4898
  • Fax: 765-564-2414
Mailing address:
  • Phone: 765-564-4898
  • Fax: 765-564-2414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08000733A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: