Provider Demographics
NPI:1750426706
Name:COATES, BROOKE W (DC)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:W
Last Name:COATES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-7517
Mailing Address - Country:US
Mailing Address - Phone:253-756-9990
Mailing Address - Fax:
Practice Address - Street 1:2627 N 21ST ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-7517
Practice Address - Country:US
Practice Address - Phone:253-756-9990
Practice Address - Fax:253-756-9992
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003199111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA115000780Medicare UPIN
WAAB38024Medicare ID - Type Unspecified