Provider Demographics
NPI:1235128968
Name:BATHERSON, BRIAN PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PATRICK
Last Name:BATHERSON
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 1:2 HANKS HILL RD
Mailing Address - Street 2:
Mailing Address - City:STORRS MANSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06268-2213
Mailing Address - Country:US
Mailing Address - Phone:860-429-8280
Mailing Address - Fax:860-429-1812
Practice Address - Street 1:2 HANKS HILL RD
Practice Address - Street 2:
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06268-2213
Practice Address - Country:US
Practice Address - Phone:860-429-8280
Practice Address - Fax:860-429-1812
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-15
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT550111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic