Provider Demographics
NPI:1275612434
Name:BROOKE-SMITH, SALLY (DC)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:
Last Name:BROOKE-SMITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 7TH AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5012
Mailing Address - Country:US
Mailing Address - Phone:212-727-9799
Mailing Address - Fax:212-239-3567
Practice Address - Street 1:352 7TH AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5012
Practice Address - Country:US
Practice Address - Phone:212-727-9799
Practice Address - Fax:212-239-3567
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005835111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX6M771Medicare ID - Type Unspecified