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NPI Code Detail

MEDICARE: DR. LORI A. BROLSMA DC

MEDICARE: DR. LORI A. BROLSMA DC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor38MC00417000NJ

General Provider Information

NPI Number : 1124028717
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LORI A. BROLSMA DC
Provider Business Mailing Address
First Line : 7 NEWARK POMPTON TURNPIKE
Second Line :
City : RIVERDALE
State : NJ
Zip : 07457
Country : US
Telephone Number : 973-831-1100
Fax Number : 973-831-6622
Provider Business Practice Location Address
First Line : 7 NEWARK POMPTON TPKE
Second Line :
City : RIVERDALE
State : NJ
Zip : 07457-1142
Country : US
Telephone Number : 973-831-1100
Fax Number : 973-831-6622
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2005
Last Update Date : 07/08/2007

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