Healthcare Provider Details

I. General information

NPI: 1093032294
Provider Name (Legal Business Name): BROADWATER FAMILY CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 BROADWAY ST
TOWNSEND MT
59644-2222
US

IV. Provider business mailing address

310 BROADWAY ST
TOWNSEND MT
59644-2222
US

V. Phone/Fax

Practice location:
  • Phone: 406-521-0078
  • Fax:
Mailing address:
  • Phone: 406-521-0078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ROXANNE M MAXWELL
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 406-521-0078