Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NX0100X | Occupational Health | 17026 | CA |
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 17026 | CA |
NPI | 1194804310 |
---|---|
Provider Name | Dr. Steven R Brodbeck |
First Address | National City, CA 91950-7650 |
Second Address | National City, CA 91950-7651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 27/10/2011 |