Provider Demographics
NPI:1013986983
Name:LEE, BROOKE ALYSSA ECKHARDT (LMT DC)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:ALYSSA ECKHARDT
Last Name:LEE
Suffix:
Gender:F
Credentials:LMT DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 MIDDLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7600
Mailing Address - Country:US
Mailing Address - Phone:563-888-5130
Mailing Address - Fax:563-888-1780
Practice Address - Street 1:1912 MIDDLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-7600
Practice Address - Country:US
Practice Address - Phone:563-888-5130
Practice Address - Fax:563-888-1780
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA496695Medicaid
IAI9004Medicare PIN