Provider Demographics
NPI:1588868046
Name:BROE, JEREMY JOSEPH (DC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:JOSEPH
Last Name:BROE
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 1:241 PEACHTREE ST NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-1424
Mailing Address - Country:US
Mailing Address - Phone:404-522-9991
Mailing Address - Fax:404-522-9890
Practice Address - Street 1:241 PEACHTREE ST STE B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-1421
Practice Address - Country:US
Practice Address - Phone:404-522-9991
Practice Address - Fax:404-522-9890
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO07816111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor