Provider Demographics
NPI:1245559046
Name:BRILLIANT CHIROPRACTIC PC
Entity Type:Organization
Organization Name:BRILLIANT CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:BUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-719-1675
Mailing Address - Street 1:17 BRILLIANT AVE
Mailing Address - Street 2:SUITE 202B
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15215-3137
Mailing Address - Country:US
Mailing Address - Phone:412-719-1675
Mailing Address - Fax:
Practice Address - Street 1:17 BRILLIANT AVE
Practice Address - Street 2:SUITE 202B
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-3137
Practice Address - Country:US
Practice Address - Phone:412-719-1675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010009111N00000X
PADC009958111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty