Provider Demographics
NPI:1215273909
Name:BROOKS CHIROPRACTIC AND REHAB LLC
Entity type:Organization
Organization Name:BROOKS CHIROPRACTIC AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-569-4903
Mailing Address - Street 1:101 W BROAD ST
Mailing Address - Street 2:SUITE 530
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4229
Mailing Address - Country:US
Mailing Address - Phone:703-536-4800
Mailing Address - Fax:
Practice Address - Street 1:101 W BROAD ST
Practice Address - Street 2:SUITE 530
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4229
Practice Address - Country:US
Practice Address - Phone:703-536-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556670111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty