Provider Demographics
NPI:1033322300
Name:BROOKFIELD FAMILY CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:BROOKFIELD FAMILY CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:KROGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-963-3999
Mailing Address - Street 1:2005 S ANKENY BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-5427
Mailing Address - Country:US
Mailing Address - Phone:515-963-3999
Mailing Address - Fax:515-963-9716
Practice Address - Street 1:2005 S ANKENY BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-5427
Practice Address - Country:US
Practice Address - Phone:515-963-3999
Practice Address - Fax:515-963-9716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI13033Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER