Provider Demographics
NPI:1073551230
Name:PINKUS, BRENTON B (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENTON
Middle Name:B
Last Name:PINKUS
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:PO BOX 1428
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-1428
Mailing Address - Country:US
Mailing Address - Phone:802-362-7512
Mailing Address - Fax:
Practice Address - Street 1:3724 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER VILLAGE
Practice Address - State:VT
Practice Address - Zip Code:05254
Practice Address - Country:US
Practice Address - Phone:802-362-7512
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0001128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVN3009Medicare ID - Type Unspecified