Provider Demographics
NPI:1073507232
Name:BASS, BROOKE (DC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:MCKEE-BASS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1398 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3543
Mailing Address - Country:US
Mailing Address - Phone:732-531-0840
Mailing Address - Fax:732-531-3330
Practice Address - Street 1:1398 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-3543
Practice Address - Country:US
Practice Address - Phone:732-531-0840
Practice Address - Fax:732-531-3330
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC001596111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
001596Medicare ID - Type Unspecified
U59882Medicare UPIN