Provider Demographics
NPI:1679568059
Name:GAJESKI, BROOKE L (DC)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:L
Last Name:GAJESKI
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:PO BOX 410
Mailing Address - Street 2:
Mailing Address - City:HARRODS CREEK
Mailing Address - State:KY
Mailing Address - Zip Code:40027-0410
Mailing Address - Country:US
Mailing Address - Phone:502-961-0011
Mailing Address - Fax:502-213-0820
Practice Address - Street 1:6304 THOMAS CT
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-7515
Practice Address - Country:US
Practice Address - Phone:502-961-0011
Practice Address - Fax:502-213-0820
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4777111NR0200X
IN08002219A111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology