Provider Demographics
NPI:1588731293
Name:BRINK, JODY MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:JODY
Middle Name:MARIE
Last Name:BRINK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 WEST ST
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-2313
Mailing Address - Country:US
Mailing Address - Phone:641-236-1084
Mailing Address - Fax:641-236-3558
Practice Address - Street 1:215 WEST ST
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-2313
Practice Address - Country:US
Practice Address - Phone:641-236-1084
Practice Address - Fax:641-236-3558
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06898111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor