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General NPI Number Information
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NPI Number | 1356598734
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Entity Type | Organization
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Legal Business Name | J ON N EIL BRODBECK DC PLLC
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 5976 ROUTE 25A
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City | WADING RIVER
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State | NY
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Zip | 11792-2001
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Country | US
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Telephone | 631-345-3035
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Fax | 631-345-3244
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Provider Business Mailing Address
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Address Line | 5976 ROUTE 25A
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City | WADING RIVER
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State | NY
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Zip | 11792-2001
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Country | US
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Telephone | 631-345-3035
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Fax | 631-345-3244
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JON NEIL BRODBECK
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Credential | D.C.
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Telephone | 631-345-3035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | X4005
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License Number State | NY
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