MEDICARE: BROOK CHIROPRACTIC, INC

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	DC27589	CA

General Provider Information

NPI Number	:	1427195544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOK CHIROPRACTIC, INC

Provider Business Mailing Address
First Line	:	11686 GATEWAY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2829
Country	:	US
Telephone Number	:	310-392-5456
Fax Number	:	310-444-5519

Provider Business Practice Location Address
First Line	:	11686 GATEWAY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2829
Country	:	US
Telephone Number	:	310-392-5456
Fax Number	:	310-444-5519

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEREMY SETH BROOK
Credential	:	DC
Telephone Number	:	310-392-5456

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	12/13/2016

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