Healthcare Provider Details

I. General information

NPI: 1710008560
Provider Name (Legal Business Name): RICHARD A BROEG DC PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 BURLINGTON PIKE
FLORENCE KY
41042-1235
US

IV. Provider business mailing address

P.O. BOX 1057
FLORENCE KY
41022-1057
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number3438
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3438
License Number StateKY

VIII. Authorized Official

Name: RICHARD A BROEG
Title or Position: OWNER
Credential: DC
Phone: 859-525-2020