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General NPI Number Information
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NPI Number | 1942748074
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Entity Type | Organization
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Legal Business Name | BRODWYN MILITARY CHIROPRACTIC
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Dates
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Enumeration Date | 02/09/2017
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | 4050 VICTORY DR
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City | COLUMBUS
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State | GA
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Zip | 31903-3995
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Country | US
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Telephone | 706-221-3456
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Fax |
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Provider Business Mailing Address
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Address Line | 4050 VICTORY DR
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City | COLUMBUS
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State | GA
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Zip | 31903-3995
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JAY BRODWYN
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Credential |
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Telephone | 706-563-3370
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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 | CHIR009758
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License Number State | GA
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