MEDICARE: DR. MICHAEL A BROSEKE 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
1	111N00000X	Chiropractor	876	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	341353287-00	OTHER	OH	WORKER'S COMPENSATION
2	000000130887	OTHER	OH	ANTHEM PROVIDER NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972506517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL A BROSEKE D.C.

Provider Business Mailing Address
First Line	:	317 E CARROL ST
Second Line	:
City	:	KENTON
State	:	OH
Zip	:	43326-1539
Country	:	US
Telephone Number	:	419-673-1163
Fax Number	:	419-673-1163

Provider Business Practice Location Address
First Line	:	317 E CARROL ST
Second Line	:
City	:	KENTON
State	:	OH
Zip	:	43326-1539
Country	:	US
Telephone Number	:	419-673-1163
Fax Number	:	419-673-1163

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	09/26/2023

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Directions to “ DR. MICHAEL A BROSEKE D.C.” Practice Location

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