Provider Demographics
NPI:1013557024
Name:BROKAW, ANDRIANNA (DC)
Entity Type:Individual
Prefix:
First Name:ANDRIANNA
Middle Name:
Last Name:BROKAW
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 1:18055 SW TV HWY
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97003-3953
Mailing Address - Country:US
Mailing Address - Phone:503-406-2020
Mailing Address - Fax:
Practice Address - Street 1:18055 SW TV HWY
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97003-3953
Practice Address - Country:US
Practice Address - Phone:503-406-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor