Healthcare Provider Details

I. General information

NPI: 1194704353
Provider Name (Legal Business Name): DOROTHY B BROLIN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2006
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5704 LAKEHAVEN DR
RALEIGH NC
27612-6402
US

IV. Provider business mailing address

5704 LAKEHAVEN DR
RALEIGH NC
27612-6402
US

V. Phone/Fax

Practice location:
  • Phone: 919-622-7111
  • Fax: 919-622-7111
Mailing address:
  • Phone: 919-622-7111
  • Fax: 919-622-7111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2036
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: