Provider Demographics
NPI:1730648411
Name:BROUSSARD, MONTE (DC)
Entity type:Individual
Prefix:DR
First Name:MONTE
Middle Name:
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 N BROADWAY ST STE A
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-2624
Mailing Address - Country:US
Mailing Address - Phone:620-308-5374
Mailing Address - Fax:
Practice Address - Street 1:2707 N BROADWAY ST STE A
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-2624
Practice Address - Country:US
Practice Address - Phone:620-308-5374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor