Healthcare Provider Details

I. General information

NPI: 1992063135
Provider Name (Legal Business Name): BROOKE NICHOLE IWANSKI D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 W COLLEGE POINTE DR STE 1
FORT MYERS FL
33919-3390
US

IV. Provider business mailing address

9101 W COLLEGE POINTE DR STE 1
FORT MYERS FL
33919-3390
US

V. Phone/Fax

Practice location:
  • Phone: 239-208-0088
  • Fax:
Mailing address:
  • Phone: 239-208-0088
  • Fax: 239-288-0804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH10604
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: