Provider Demographics
NPI:1225016686
Name:BRINKER, WILLIAM ELWOOD II (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ELWOOD
Last Name:BRINKER
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:ELWOOD
Other - Last Name:BRINKER
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1822 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2706
Mailing Address - Country:US
Mailing Address - Phone:570-421-8590
Mailing Address - Fax:
Practice Address - Street 1:1822 N 5TH ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2706
Practice Address - Country:US
Practice Address - Phone:570-421-8590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001224L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350055564OtherRAILROAD MEDICARE
PA07730780Medicaid
BR116065Medicare ID - Type Unspecified
PA07730780Medicaid