Provider Demographics
NPI:1174933055
Name:BREITBACH, BROOKE (DC)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:
Last Name:BREITBACH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 LAKESTONE VILLAGE LN STE 105
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-4449
Mailing Address - Country:US
Mailing Address - Phone:919-577-2225
Mailing Address - Fax:919-577-2226
Practice Address - Street 1:1501 LAKESTONE VILLAGE LN STE 105
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-4449
Practice Address - Country:US
Practice Address - Phone:919-577-2225
Practice Address - Fax:919-577-2226
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5918111N00000X
NC4495111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor