Provider Demographics
NPI:1962696872
Name:BROOK, JEREMY SETH (DC)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:SETH
Last Name:BROOK
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 1:11686 GATEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2829
Mailing Address - Country:US
Mailing Address - Phone:310-392-5456
Mailing Address - Fax:
Practice Address - Street 1:11686 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2829
Practice Address - Country:US
Practice Address - Phone:310-392-5456
Practice Address - Fax:310-444-5519
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor