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NPI Code Detail

MEDICARE: DR. KENICE ANNE BROUGHMAN D.C.

MEDICARE: DR. KENICE ANNE BROUGHMAN D.C.
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
1111NN1001XNutrition ChiropractorCH0006374FL
2111NN1001XNutrition Chiropractor038.005796IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215944855
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENICE ANNE BROUGHMAN D.C.
Provider Business Mailing Address
First Line : 4555 N LINCOLN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-2102
Country : US
Telephone Number : 773-328-8153
Fax Number :
Provider Business Practice Location Address
First Line : 4555 N LINCOLN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-2102
Country : US
Telephone Number : 386-763-2763
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2006
Last Update Date : 01/13/2025

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