Provider Demographics
NPI:1407079288
Name:BROOKS, DARREN K (DOM, LAC)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:K
Last Name:BROOKS
Suffix:
Gender:M
Credentials:DOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 SW BOND AVE
Mailing Address - Street 2:504
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4706
Mailing Address - Country:US
Mailing Address - Phone:505-850-6965
Mailing Address - Fax:
Practice Address - Street 1:3939 SW BOND AVE
Practice Address - Street 2:504
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4706
Practice Address - Country:US
Practice Address - Phone:505-850-6965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM947171100000X
ORAC160378171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist