Provider Demographics
NPI:1639232432
Name:BROOKS, STEPHEN R JR (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:BROOKS
Suffix:JR
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 1:7809 W COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33351-4382
Mailing Address - Country:US
Mailing Address - Phone:954-741-2622
Mailing Address - Fax:954-380-8494
Practice Address - Street 1:7809 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33351-4382
Practice Address - Country:US
Practice Address - Phone:954-741-2622
Practice Address - Fax:954-380-8494
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU99914Medicare UPIN
FLK5736Medicare PIN