Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jack Broaddus, ATC

Individual provider Athletic Trainer · NPI 1134805096

Jack Broaddus, ATC is an Athletic Trainer in Ann Arbor, Michigan. Licensed in Michigan. Registered with an NPI since 2023.

Licensed in
MI
In the registry since
2023
What do these letters mean?
ATC — Certified Athletic Trainer
Prevents and treats sport and activity injuries.

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Practice location Address checks out

1200 S State St
Ann Arbor, MI 48109
Phone: (734) 647-2583
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Athletic Trainer (primary) Taxonomy 2255A2300X · Licence 2601002903 (MI)

Record details

NPI number1134805096
Entity typeIndividual (Type 1)
GenderMale
Credentials ATC
Sole proprietorNo
NPI enumeratedJune 26, 2023
Last updated in NPPESJune 26, 2023
Certification dateJanuary 18, 2023
Mailing address11309 Porter Pike, Oakland, KY 42159

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