Provider Demographics
NPI:1518356039
Name:VAN KIRK, BROOKE (DC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:VAN KIRK
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 1:8546 BRIAR ROSE PT
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-7819
Mailing Address - Country:US
Mailing Address - Phone:954-649-3633
Mailing Address - Fax:561-740-0714
Practice Address - Street 1:4971 LE CHALET BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-1418
Practice Address - Country:US
Practice Address - Phone:561-733-5590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11397111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor