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NPI Code Detail

MEDICARE: JAY BRODWYN CLINICARE OF COLUMBUS INC

MEDICARE: JAY BRODWYN CLINICARE OF COLUMBUS INC
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
1111N00000XChiropractorDC1811GA

General Provider Information

NPI Number : 1851325104
Entity Type Code : Organization
Provider Name (Legal Business Name) : JAY BRODWYN CLINICARE OF COLUMBUS INC
Provider Business Mailing Address
First Line : 3624 EDGEWOOD RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31907-2184
Country : US
Telephone Number : 706-563-3370
Fax Number : 706-563-3501
Provider Business Practice Location Address
First Line : 3624 EDGEWOOD RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31907-2184
Country : US
Telephone Number : 706-563-3370
Fax Number : 706-563-3501
Authorized Official
Title or Position : DOCTOR
Name : IVAN JAY BRODWYN
Credential : DC
Telephone Number : 706-563-3370
Provider Enumeration Date : 07/11/2006
Last Update Date : 03/04/2008

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