Provider Demographics
NPI:1134267578
Name:BROZOVICH, WILLIAM (DC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:BROZOVICH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1654 S COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-7216
Mailing Address - Country:US
Mailing Address - Phone:662-335-2854
Mailing Address - Fax:662-335-0502
Practice Address - Street 1:1654 S COLORADO ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-7216
Practice Address - Country:US
Practice Address - Phone:662-335-2854
Practice Address - Fax:662-335-0502
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02618OtherMEDICARE PROVIDER GROUP
MS00126651OtherMEDICAID INDIVID PROVIDER
MS09016212Medicaid
MS09016212Medicaid