Provider Demographics
NPI:1730759994
Name:BROUGHMAN, STEPHEN ALLAN II (DC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ALLAN
Last Name:BROUGHMAN
Suffix:II
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:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-0628
Mailing Address - Country:US
Mailing Address - Phone:478-987-9666
Mailing Address - Fax:
Practice Address - Street 1:1207 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-4309
Practice Address - Country:US
Practice Address - Phone:478-987-9666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010196111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor