Provider Demographics
NPI:1962556837
Name:BROOKS, DELMAR WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:DELMAR
Middle Name:WAYNE
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 1:1203 E PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-7355
Mailing Address - Country:US
Mailing Address - Phone:903-938-0050
Mailing Address - Fax:903-938-8081
Practice Address - Street 1:1203 E PINECREST DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-7355
Practice Address - Country:US
Practice Address - Phone:903-938-0050
Practice Address - Fax:903-938-8081
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5663111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603455OtherBCBS PROVIDER #
TXDC5663OtherSTATE LICENSE #
TX603455OtherBCBS PROVIDER #
TX603455Medicare ID - Type Unspecified