Provider Demographics
NPI:1245252097
Name:BROOKS, WAYNE ALVIN (DC)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:ALVIN
Last Name:BROOKS
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:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-0485
Mailing Address - Country:US
Mailing Address - Phone:620-221-3630
Mailing Address - Fax:620-221-3630
Practice Address - Street 1:1404 MAIN
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-0485
Practice Address - Country:US
Practice Address - Phone:620-221-3630
Practice Address - Fax:620-221-3630
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0103754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KST43960Medicare ID - Type Unspecified