Provider Demographics
NPI:1093714081
Name:ARNOLD, BRIAN ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ANTHONY
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BRIAN
Other - Middle Name:ANTHONY
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:31930 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-1418
Mailing Address - Country:US
Mailing Address - Phone:586-296-0991
Mailing Address - Fax:586-296-7611
Practice Address - Street 1:31930 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082
Practice Address - Country:US
Practice Address - Phone:586-296-0991
Practice Address - Fax:586-296-7611
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004762111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11270964OtherMICHIGAN PROVIDER ID #
MI2301004762OtherMICHIGAN LICENCE NUMBER
MI2301004762OtherMICHIGAN LICENCE NUMBER
MI0E05150Medicare ID - Type UnspecifiedCHIROPRACTOR