Provider Demographics
NPI:1356539571
Name:BRODERICK, LINDSAY MARGRET WEBER (DC)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:MARGRET WEBER
Last Name:BRODERICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:LINDSAY
Other - Middle Name:MARGRET
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3816 WOODRUFF AVE
Mailing Address - Street 2:#202
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-2147
Mailing Address - Country:US
Mailing Address - Phone:562-420-5433
Mailing Address - Fax:562-420-5434
Practice Address - Street 1:3816 WOODRUFF AVE
Practice Address - Street 2:#202
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-2147
Practice Address - Country:US
Practice Address - Phone:562-420-5433
Practice Address - Fax:562-420-5434
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGT362AMedicare UPIN