MEDICARE: DR. CARMEN NOELLE BRODEUR 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
1	111N00000X	Chiropractor	6042	AZ

General Provider Information

NPI Number	:	1174660773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARMEN NOELLE BRODEUR DC

Provider Business Mailing Address
First Line	:	PO BOX 36975
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85067-6975
Country	:	US
Telephone Number	:	602-532-9544
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 E OSBORN RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2327
Country	:	US
Telephone Number	:	602-532-9544
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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