Provider Demographics
NPI:1184814105
Name:KALANICK, BROOKE LARAE (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:LARAE
Last Name:KALANICK
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 W 11TH ST # 103
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-2212
Mailing Address - Country:US
Mailing Address - Phone:646-678-6080
Mailing Address - Fax:646-607-0127
Practice Address - Street 1:247 W 11TH ST # 103
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-2212
Practice Address - Country:US
Practice Address - Phone:646-678-6080
Practice Address - Fax:646-607-0127
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003283-1171100000X
WA1352175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist