Provider Demographics
NPI:1083670897
Name:BREZINSKI, CHAD DENNIS (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:DENNIS
Last Name:BREZINSKI
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 1:807 WEST AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-8230
Mailing Address - Country:US
Mailing Address - Phone:770-334-2126
Mailing Address - Fax:770-334-2946
Practice Address - Street 1:807 WEST AVE
Practice Address - Street 2:SUITE G
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-8230
Practice Address - Country:US
Practice Address - Phone:770-334-2126
Practice Address - Fax:770-334-2946
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA009502111N00000X
GACHIR008980111N00000X
AZ7990111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101768479Medicaid
PA101768479Medicaid
PAV09313Medicare UPIN