Provider Demographics
NPI:1043792724
Name:SMITH, BROOKE MORGAN (DC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:MORGAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:MORGAN
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5112 W TAFT RD STE B1
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4975
Mailing Address - Country:US
Mailing Address - Phone:315-452-9420
Mailing Address - Fax:
Practice Address - Street 1:5112 W TAFT RD STE B1
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4975
Practice Address - Country:US
Practice Address - Phone:315-452-9420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX013095-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor