Provider Demographics
NPI:1073686176
Name:BELLIS, BRETT A (DC)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:A
Last Name:BELLIS
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 1:129 LOCUST STREET
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17023
Mailing Address - Country:US
Mailing Address - Phone:717-362-1288
Mailing Address - Fax:717-362-1287
Practice Address - Street 1:129 LOCUST STREET
Practice Address - Street 2:
Practice Address - City:ELIZABETHVILLE
Practice Address - State:PA
Practice Address - Zip Code:17023
Practice Address - Country:US
Practice Address - Phone:717-362-1288
Practice Address - Fax:717-362-1287
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007770L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1595354OtherBC
PABC061370Medicare PIN