Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 3189 | OH |
NPI | 1083766232 |
---|---|
Provider Name | Dr. Michael Wayne Broughton |
First Address | Cincinnati, OH 45258-0529 |
Second Address | Cincinnati, OH 45237-3232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 08/07/2007 |