Provider Demographics
NPI:1245205004
Name:CASE, BRYAN D (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:D
Last Name:CASE
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 1:34A MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINTERS
Mailing Address - State:CA
Mailing Address - Zip Code:95694-1723
Mailing Address - Country:US
Mailing Address - Phone:530-795-4211
Mailing Address - Fax:530-795-0241
Practice Address - Street 1:34A MAIN ST
Practice Address - Street 2:
Practice Address - City:WINTERS
Practice Address - State:CA
Practice Address - Zip Code:95694-1723
Practice Address - Country:US
Practice Address - Phone:530-795-4211
Practice Address - Fax:530-795-0241
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23221Medicare ID - Type Unspecified