1356539571 NPI number — MRS. LINDSAY MARGRET WEBER BRODERICK D.C.

Table of content: MRS. LINDSAY MARGRET WEBER BRODERICK D.C. (NPI 1356539571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356539571 NPI number — MRS. LINDSAY MARGRET WEBER BRODERICK D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRODERICK
Provider First Name:
LINDSAY
Provider Middle Name:
MARGRET WEBER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEBER
Provider Other First Name:
LINDSAY
Provider Other Middle Name:
MARGRET
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356539571
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3816 WOODRUFF AVE
Provider Second Line Business Mailing Address:
#202
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90808-2147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-420-5433
Provider Business Mailing Address Fax Number:
562-420-5434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3816 WOODRUFF AVE
Provider Second Line Business Practice Location Address:
#202
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90808-2147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-420-5433
Provider Business Practice Location Address Fax Number:
562-420-5434
Provider Enumeration Date:
10/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC30736 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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