Provider Demographics
NPI:1023266657
Name:BROOKS MANAGEMENT, INC
Entity type:Organization
Organization Name:BROOKS MANAGEMENT, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:LINDEN
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:540-710-7300
Mailing Address - Street 1:4721 JEFFERSON DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-4257
Mailing Address - Country:US
Mailing Address - Phone:540-710-7300
Mailing Address - Fax:540-710-7301
Practice Address - Street 1:4721 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4257
Practice Address - Country:US
Practice Address - Phone:540-710-7300
Practice Address - Fax:540-710-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555792111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09050Medicare PIN