Provider Demographics
NPI:1841970449
Name:BROOME, VANESSA LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:LYNN
Last Name:BROOME
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:VANESSA
Other - Middle Name:LYNN
Other - Last Name:BROOME
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:12 LORAINE ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-1807
Mailing Address - Country:US
Mailing Address - Phone:631-365-4065
Mailing Address - Fax:
Practice Address - Street 1:901 STEWART AVE STE 285
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-6800
Practice Address - Country:US
Practice Address - Phone:516-742-5715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor