Provider Demographics
NPI:1750558599
Name:BROOKS SPINAL CARE, PC
Entity type:Organization
Organization Name:BROOKS SPINAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-587-7111
Mailing Address - Street 1:1722 S CARSON AVE
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-4666
Mailing Address - Country:US
Mailing Address - Phone:918-587-7111
Mailing Address - Fax:918-587-1177
Practice Address - Street 1:1722 S CARSON AVE
Practice Address - Street 2:SUITE 3100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-4666
Practice Address - Country:US
Practice Address - Phone:918-587-7111
Practice Address - Fax:918-587-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKM5025225700000X
OK3579111N00000X
OK1618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty