Provider Demographics
NPI:1083726061
Name:BRIAN THALHAMER
Entity Type:Organization
Organization Name:BRIAN THALHAMER
Other - Org Name:WELLNESS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:THALHAMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-575-8988
Mailing Address - Street 1:635 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4428
Mailing Address - Country:US
Mailing Address - Phone:707-575-8988
Mailing Address - Fax:
Practice Address - Street 1:635 5TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4428
Practice Address - Country:US
Practice Address - Phone:707-575-8988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty