Provider Demographics
NPI:1275545840
Name:MCINTYRE, BRIAN K (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:K
Last Name:MCINTYRE
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 1:1415 S BIG BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-2203
Mailing Address - Country:US
Mailing Address - Phone:314-644-7776
Mailing Address - Fax:
Practice Address - Street 1:1415 S BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-2203
Practice Address - Country:US
Practice Address - Phone:314-644-7776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE005664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000032170Medicare PIN
MOU05432Medicare UPIN