Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4935 | KY |
NPI | 1861470536 |
---|---|
Provider Name | Andria L Brooks |
First Address | Calhoun, KY 42327 |
Second Address | Calhoun, KY 42327-9782 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2006 |
Last Update Date | 07/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
85003663 | (05) | KY |