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General NPI Number Information
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NPI Number | 1427195544
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Entity Type | Organization
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Legal Business Name | BROOK CHIROPRACTIC, INC
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 11686 GATEWAY BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90064-2829
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Country | US
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Telephone | 310-392-5456
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Fax | 310-444-5519
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Provider Business Mailing Address
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Address Line | 11686 GATEWAY BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90064-2829
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Country | US
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Telephone | 310-392-5456
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Fax | 310-444-5519
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEREMY SETH BROOK
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Credential | DC
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Telephone | 310-392-5456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC27589
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License Number State | CA
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