Healthcare Provider Details

I. General information

NPI: 1710941885
Provider Name (Legal Business Name): RICHARD A. BROEG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 BURLINGTON PIKE
FLORENCE KY
41042-1235
US

IV. Provider business mailing address

8850 LOWER RIVER RD
RABBIT HASH KY
41005-8696
US

V. Phone/Fax

Practice location:
  • Phone: 859-525-2020
  • Fax: 859-525-0472
Mailing address:
  • Phone: 859-689-1317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3438
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: