=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780857771
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTOPHER BROOKES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2008
-----------------------------------------------------
Last Update Date | 07/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3458 WINDER HWY SUITE 120
-----------------------------------------------------
City | FLOWERY BRANCH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-503-0500
-----------------------------------------------------
Fax | 770-503-0500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3458 WINDER HWY SUITE 120
-----------------------------------------------------
City | FLOWERY BRANCH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-503-0500
-----------------------------------------------------
Fax | 770-503-0635
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR / OWNER
-----------------------------------------------------
Name | CHRISTOPHER JONATHAN LEIGH BROOKES
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 770-503-0500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 6847
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------