MEDICARE: CHANDRA STEPHANIE RAE BROOKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372500000X	Chore Provider

General Provider Information

NPI Number	:	1033541651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDRA STEPHANIE RAE BROOKS

Provider Business Mailing Address
First Line	:	8312 OLD MILL RD
Second Line	:	P.O. BOX 283
City	:	TROY
State	:	IL
Zip	:	62294-2623
Country	:	US
Telephone Number	:	270-893-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	8312 OLD MILL RD
Second Line	:
City	:	TROY
State	:	IL
Zip	:	62294-2623
Country	:	US
Telephone Number	:	270-893-3900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2013
Last Update Date	:	08/06/2013

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