Provider Demographics
NPI:1780857771
Name:CHRISTOPHER BROOKES
Entity Type:Organization
Organization Name:CHRISTOPHER BROOKES
Other - Org Name:LIGHTHOUSE CHIROPRACTIC CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JONATHAN LEIGH
Authorized Official - Last Name:BROOKES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-503-0500
Mailing Address - Street 1:3458 WINDER HWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542
Mailing Address - Country:US
Mailing Address - Phone:770-503-0500
Mailing Address - Fax:770-503-0635
Practice Address - Street 1:3458 WINDER HWY
Practice Address - Street 2:SUITE 120
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542
Practice Address - Country:US
Practice Address - Phone:770-503-0500
Practice Address - Fax:770-503-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU86845Medicare UPIN
GA35ZCGLZMedicare PIN