MEDICARE: DR. BROOKE L GAJESKI DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0200X	Radiology Chiropractor	4777	KY
2	111NR0200X	Radiology Chiropractor	08002219A	IN

General Provider Information

NPI Number	:	1679568059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BROOKE L GAJESKI DC

Provider Business Mailing Address
First Line	:	PO BOX 410
Second Line	:
City	:	HARRODS CREEK
State	:	KY
Zip	:	40027-0410
Country	:	US
Telephone Number	:	502-961-0011
Fax Number	:	502-213-0820

Provider Business Practice Location Address
First Line	:	6304 THOMAS CT
Second Line	:
City	:	PROSPECT
State	:	KY
Zip	:	40059-7515
Country	:	US
Telephone Number	:	502-961-0011
Fax Number	:	502-213-0820

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	07/21/2022

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