Provider Demographics
NPI:1154675239
Name:BREWER CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BREWER CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-337-3125
Mailing Address - Street 1:PO BOX 2578
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:AZ
Mailing Address - Zip Code:85936-2578
Mailing Address - Country:US
Mailing Address - Phone:928-337-3125
Mailing Address - Fax:
Practice Address - Street 1:1200 W CLEVELAND
Practice Address - Street 2:SUITE 6
Practice Address - City:SAINT JOHNS
Practice Address - State:AZ
Practice Address - Zip Code:85936
Practice Address - Country:US
Practice Address - Phone:928-337-3125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7695261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care