Provider Demographics
NPI:1164768776
Name:BREWSTER CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:BREWSTER CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:0WNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:COPENHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-689-3516
Mailing Address - Street 1:PO BOX 1521
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:WA
Mailing Address - Zip Code:98812-1521
Mailing Address - Country:US
Mailing Address - Phone:509-689-3516
Mailing Address - Fax:509-689-3516
Practice Address - Street 1:319 EAST MAIN AVE
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:WA
Practice Address - Zip Code:98812
Practice Address - Country:US
Practice Address - Phone:509-689-3516
Practice Address - Fax:509-689-3516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60304364111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty