Provider Demographics
NPI:1083818447
Name:DANIELSON, BROOKE KRISTEN (LMP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:KRISTEN
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 NW 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-9387
Mailing Address - Country:US
Mailing Address - Phone:360-834-2945
Mailing Address - Fax:
Practice Address - Street 1:GRAFTON FAMILY CHIROPRACTIC 615 SE CHKALOV DR.
Practice Address - Street 2:SUITE 7
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683
Practice Address - Country:US
Practice Address - Phone:360-885-1767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA0024065174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist