Provider Demographics
NPI:1750669255
Name:BROOKS, ALYSSA CHRISTINE (DC)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:CHRISTINE
Last Name:BROOKS
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 1:717 CHURCHILL ST
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-2016
Mailing Address - Country:US
Mailing Address - Phone:715-258-7001
Mailing Address - Fax:715-258-7048
Practice Address - Street 1:717 CHURCHILL ST
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-2016
Practice Address - Country:US
Practice Address - Phone:715-258-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4760012111N00000X
WI4760-012111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111N00000XChiropractic ProvidersChiropractor