DR. JESSE BRODERSON (D.C.) – Chiropractor, NPI 1487738852

DR. JESSE BRODERSON (D.C.) is a healthcare provider. based in Kailua kona, Hawaii. specializing in CHIROPRACTIC. They hold the professional credentials D.C.. They hold a License No. 978 (HI). The NPI Number for DR. JESSE BRODERSON (D.C.) is 1487738852

Main info

Male
23 Years Of Experience
Name
DR. JESSE BRODERSON (D.C.)
NPI
1487738852
Phone
(808) 329-7797
Address
74-5620 PALANI RD STE A
Enumeration Date
24 October 2006
Last Update Date
8 January 2011

Doctor Profile

Medical School Name
LIFE CHIROPRACTIC COLLEGE - WEST
Secondary Phone
8083297797
Graduation Year
2003 (23 years ago)
PAC ID
8527056845
Group Practice PAC ID
8325036643
Professional Enrollment ID
I20040505000401
Address ID
HI967403114KA74XXXRDXX401
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience52
Completeness75
Years active:19State licenses:1Digital endpointsOther names

132 CHIROPRACTIC in HI

Provider Addresses for DR. JESSE BRODERSON (D.C.)

  • 74-5620 PALANI RD STE A

    SUITE 102

    KAILUA KONA, HI 967403640

    Phone: (808) 329-7797

    Fax: (808) 329-2748

    Type: Location

  • 74-5620A PALANI RD

    SUITE 102

    KAILUA KONA, HI 967403100

    Phone: (808) 329-7797

    Fax: (808) 329-2748

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2004-05-05

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20040505000401IChiropracticHITBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
98941Chiropractic manipulative treatment, 3-4 spinal regions33767$0
View full utilization report →

Insurance plans in this area (ZIP 96740)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 8325036643View full group profile
NameSpecialtyState
C H I R O P R A C T I CHI

Reviews

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Frequently asked questions

How do I look up DR. JESSE BRODERSON (D.C.) by NPI?
Use NPI 1487738852 when you need to reference DR. JESSE BRODERSON (D.C.) in forms, claims, or directories.
Is DR. JESSE BRODERSON (D.C.) currently active in the NPI registry?
CMS-published data lists DR. JESSE BRODERSON (D.C.) as an active registrant.
What field does DR. JESSE BRODERSON (D.C.) work in?
You can think of DR. JESSE BRODERSON (D.C.) as practicing within Chiropractor. Clinical services aligned with this taxonomy classification.
Where does public data place DR. JESSE BRODERSON (D.C.)?
The snapshot lists Kailua Kona, Hawaii for DR. JESSE BRODERSON (D.C.); download NPPES for the complete set.
What if Kailua Kona, Hawaii seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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