Provider Demographics
NPI:1760819130
Name:CONZO, BROOKE DANIELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:DANIELLE
Last Name:CONZO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:DANIELLE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6350 EUBANK BLVD NE
Mailing Address - Street 2:APT 1223
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7358
Mailing Address - Country:US
Mailing Address - Phone:386-506-2829
Mailing Address - Fax:
Practice Address - Street 1:7930 WYOMING BLVD NE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6018
Practice Address - Country:US
Practice Address - Phone:505-247-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor