Provider Demographics
NPI:1487063301
Name:BROOKVIEW WELLNESS
Entity type:Organization
Organization Name:BROOKVIEW WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BREITBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-389-1521
Mailing Address - Street 1:7224 BLUE JUNIPER CT
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-5472
Mailing Address - Country:US
Mailing Address - Phone:319-389-1521
Mailing Address - Fax:
Practice Address - Street 1:137 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-1933
Practice Address - Country:US
Practice Address - Phone:919-577-2225
Practice Address - Fax:919-577-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2014-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4495111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty