Provider Demographics
NPI:1790026441
Name:BROOKS CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:BROOKS CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKS
Authorized Official - Middle Name:
Authorized Official - Last Name:LABER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-456-6611
Mailing Address - Street 1:1100 4TH AVE E
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-1600
Mailing Address - Country:US
Mailing Address - Phone:952-456-6611
Mailing Address - Fax:952-456-6631
Practice Address - Street 1:1100 4TH AVE E
Practice Address - Street 2:SUITE 220
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-1600
Practice Address - Country:US
Practice Address - Phone:952-456-6611
Practice Address - Fax:952-456-6631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty