MEDICARE: DR. SALLY BROOKE-SMITH D.C.

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	111N00000X	Chiropractor	X005835	NY

General Provider Information

NPI Number	:	1275612434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALLY BROOKE-SMITH D.C.

Provider Business Mailing Address
First Line	:	352 7TH AVE
Second Line	:	SUITE 205
City	:	NEW YORK
State	:	NY
Zip	:	10001-5012
Country	:	US
Telephone Number	:	212-727-9799
Fax Number	:	212-239-3567

Provider Business Practice Location Address
First Line	:	352 7TH AVE
Second Line	:	SUITE 205
City	:	NEW YORK
State	:	NY
Zip	:	10001-5012
Country	:	US
Telephone Number	:	212-727-9799
Fax Number	:	212-239-3567

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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