Provider Demographics
NPI:1043835978
Name:BROSCO CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BROSCO CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:401-486-9850
Mailing Address - Street 1:1127 W WRIGHTWOOD AVE # 3W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1314
Mailing Address - Country:US
Mailing Address - Phone:401-486-9850
Mailing Address - Fax:
Practice Address - Street 1:500 N DEARBORN ST STE 700
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-3397
Practice Address - Country:US
Practice Address - Phone:737-683-2201
Practice Address - Fax:773-260-1612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty