Provider Demographics
NPI:1205825627
Name:TALLENTS, BRETT RILEY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:RILEY
Last Name:TALLENTS
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 1:53 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-1844
Mailing Address - Country:US
Mailing Address - Phone:315-593-7555
Mailing Address - Fax:315-598-8352
Practice Address - Street 1:53 S 3RD ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1844
Practice Address - Country:US
Practice Address - Phone:315-593-7555
Practice Address - Fax:315-598-8352
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004785111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY51059-BMedicare ID - Type Unspecified
NY26759Medicare UPIN