Provider Demographics
NPI:1104859404
Name:PRAX, BRIAN ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ANDREW
Last Name:PRAX
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 1:313 SECOND STREET SE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5654
Mailing Address - Country:US
Mailing Address - Phone:434-977-5433
Mailing Address - Fax:888-241-8375
Practice Address - Street 1:313 SECOND STREET SE
Practice Address - Street 2:SUITE 107
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5654
Practice Address - Country:US
Practice Address - Phone:434-977-5433
Practice Address - Fax:888-241-8375
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA68-0483605OtherFEDERAL TAX ID#