Provider Demographics
NPI:1659678092
Name:FOREMAN, BROOKE CHANTELLE (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:CHANTELLE
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4-976 KUHIO HWY
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-1572
Mailing Address - Country:US
Mailing Address - Phone:808-238-4887
Mailing Address - Fax:
Practice Address - Street 1:4-976 KUHIO HWY
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1572
Practice Address - Country:US
Practice Address - Phone:808-238-4887
Practice Address - Fax:762-220-1801
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT104970173C00000X
TXAC01256171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No173C00000XOther Service ProvidersReflexologist