Healthcare Provider Details

I. General information

NPI: 1528275674
Provider Name (Legal Business Name): ANITA GAIL BROOKS DC CCSP LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11790 SW TIMBERLINE DRIVE
BEAVERTON OR
97008-6301
US

IV. Provider business mailing address

11790 SW TIMBERLINE DRIVE
BEAVERTON OR
97008-6301
US

V. Phone/Fax

Practice location:
  • Phone: 503-641-9414
  • Fax:
Mailing address:
  • Phone: 503-641-9414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2835
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number3677
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3322
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: