Provider Demographics
NPI:1053310748
Name:BRISBY, MARK W (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:BRISBY
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 1:5638 HOLLISTER AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-3474
Mailing Address - Country:US
Mailing Address - Phone:805-681-7273
Mailing Address - Fax:805-681-7253
Practice Address - Street 1:5638 HOLLISTER AVE
Practice Address - Street 2:STE 301
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-3474
Practice Address - Country:US
Practice Address - Phone:805-681-7273
Practice Address - Fax:805-681-7253
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19063DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU08298Medicare UPIN
CADC19063AMedicare PIN