Provider Demographics
NPI:1073699351
Name:BRISSON, DOUGLAS PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:PAUL
Last Name:BRISSON
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 1:2015 IONOSPHERE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-8511
Mailing Address - Country:US
Mailing Address - Phone:303-678-8489
Mailing Address - Fax:888-551-2163
Practice Address - Street 1:2015 IONOSPHERE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-8511
Practice Address - Country:US
Practice Address - Phone:303-678-8489
Practice Address - Fax:888-551-2163
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2270111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO202497907Medicare UPIN
COC805140Medicare ID - Type Unspecified