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General NPI Number Information
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NPI Number | 1760726301
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Entity Type | Organization
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Legal Business Name | BROTHERTON FAMILY AND SPORTS CHIROPRACTIC P.C.
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Dates
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Enumeration Date | 11/20/2012
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 406 MAIN ST
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City | LAKE VIEW
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State | IA
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Zip | 51450-7710
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Country | US
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Telephone | 712-665-4099
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Fax |
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Provider Business Mailing Address
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Address Line | 406 MAIN ST
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City | LAKE VIEW
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State | IA
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Zip | 51450-7710
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Country | US
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Telephone | 712-665-4099
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Fax |
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Authorized Official
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Title or Position | D.C.
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Name | AMANDA BENGFORD
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Credential |
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Telephone | 712-665-4099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 007583
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License Number State | IA
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