Provider Demographics
NPI:1043246010
Name:COTTER, BRIAN TIMOTHY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:TIMOTHY
Last Name:COTTER
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 1:512 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-6405
Mailing Address - Country:US
Mailing Address - Phone:508-752-7521
Mailing Address - Fax:
Practice Address - Street 1:512 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-6405
Practice Address - Country:US
Practice Address - Phone:508-752-7521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH 2356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAU75354Medicare UPIN
MAY45247Medicare PIN