Provider Demographics
NPI:1285605154
Name:BROOKS, JONATHAN DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DAVID
Last Name:BROOKS
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 1:767 MADISON ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3340
Mailing Address - Country:US
Mailing Address - Phone:540-825-5491
Mailing Address - Fax:540-825-6493
Practice Address - Street 1:767 MADISON ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3340
Practice Address - Country:US
Practice Address - Phone:540-825-5491
Practice Address - Fax:540-825-6493
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor