Provider Demographics
NPI:1417900648
Name:BROOKS, CLARENCE LINDEN II (DC)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:LINDEN
Last Name:BROOKS
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 JEFFERSON DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-4257
Mailing Address - Country:US
Mailing Address - Phone:540-710-7300
Mailing Address - Fax:540-710-7301
Practice Address - Street 1:4721 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4257
Practice Address - Country:US
Practice Address - Phone:540-710-7300
Practice Address - Fax:540-710-7301
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555792111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA610542100OtherOWCP WORKERS COMP
VA2235537OtherFIRST HEALTH
VA669438OtherACN GROUP
VA139983OtherANTHEM
VA5543315OtherCCN NETWORK
VA2235537OtherFIRST HEALTH
VA00V917B01Medicare ID - Type UnspecifiedINDIVIDUAL