Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 4760012 | WI |
Y | 111NP0017X | Pediatric Chiropractor | 4760-012 | WI |
NPI | 1750669255 |
---|---|
Provider Name | Dr. Alyssa Christine Brooks |
First Address | Waupaca, WI 54981-2016 |
Second Address | Waupaca, WI 54981-2016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2011 |
Last Update Date | 01/11/2018 |