Provider Demographics
NPI:1164472999
Name:BROOKS, JILL ANN BURCH (RN DC)
Entity Type:Individual
Prefix:DR
First Name:JILL ANN
Middle Name:BURCH
Last Name:BROOKS
Suffix:
Gender:F
Credentials:RN DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 MONROE AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618
Mailing Address - Country:US
Mailing Address - Phone:585-385-8790
Mailing Address - Fax:585-385-0657
Practice Address - Street 1:3300 MONROE AVE
Practice Address - Street 2:STE 204
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-385-8790
Practice Address - Fax:585-385-0657
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008230111N00000X
NY423551163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC3458Medicare ID - Type Unspecified
61530Medicare UPIN