Provider Demographics
NPI:1225929151
Name:BRODER, NICHOLAS ANDREW (DC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ANDREW
Last Name:BRODER
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:N8420 STATE ROAD 57
Mailing Address - Street 2:
Mailing Address - City:ELKHART LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53020-2040
Mailing Address - Country:US
Mailing Address - Phone:920-207-7864
Mailing Address - Fax:
Practice Address - Street 1:516 S WISCONSIN DR
Practice Address - Street 2:
Practice Address - City:HOWARDS GROVE
Practice Address - State:WI
Practice Address - Zip Code:53083-1261
Practice Address - Country:US
Practice Address - Phone:920-565-3922
Practice Address - Fax:920-565-2142
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6324-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor