Provider Demographics
NPI:1366911026
Name:BROOKS, MYLES JAMES (DC)
Entity type:Individual
Prefix:
First Name:MYLES
Middle Name:JAMES
Last Name:BROOKS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 8TH AVE N
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-0759
Mailing Address - Country:US
Mailing Address - Phone:701-480-9120
Mailing Address - Fax:
Practice Address - Street 1:4350 S WASHINGTON ST STE 100
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-7184
Practice Address - Country:US
Practice Address - Phone:701-480-9120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-24
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor