Provider Demographics
NPI:1942920285
Name:ROBERTSON, BROOKS MACKENZY (DC)
Entity Type:Individual
Prefix:DR
First Name:BROOKS
Middle Name:MACKENZY
Last Name:ROBERTSON
Suffix:
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 1:9655 WHARF RD APT 431
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5854
Mailing Address - Country:US
Mailing Address - Phone:479-414-0856
Mailing Address - Fax:
Practice Address - Street 1:106 N DENTON TAP RD STE 270
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2140
Practice Address - Country:US
Practice Address - Phone:972-694-1898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor