Healthcare Provider Details

I. General information

NPI: 1386563955
Provider Name (Legal Business Name): BROOKE LEIGHANN PIETERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 W MAIN ST STE 2
VICTOR NY
14564-1198
US

IV. Provider business mailing address

1561 VAN AUKEN RD
NEWARK NY
14513-9349
US

V. Phone/Fax

Practice location:
  • Phone: 585-924-3610
  • Fax:
Mailing address:
  • Phone: 585-749-0515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number014077
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: