Provider Demographics
NPI:1235213430
Name:TIU, BRIAN C (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:C
Last Name:TIU
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 1:200 GREAT RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-2711
Mailing Address - Country:US
Mailing Address - Phone:781-202-7352
Mailing Address - Fax:
Practice Address - Street 1:200 GREAT RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-2711
Practice Address - Country:US
Practice Address - Phone:781-202-7352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034494111N00000X
VA0104556549111N00000X
MA3192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8857138Medicare ID - Type Unspecified
WAV07346Medicare UPIN