Provider Demographics
NPI:1356488498
Name:WIERSMA, BRIAN JAMES (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JAMES
Last Name:WIERSMA
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 1:525 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3460
Mailing Address - Country:US
Mailing Address - Phone:615-449-6700
Mailing Address - Fax:
Practice Address - Street 1:201 THOMPSON LN
Practice Address - Street 2:SUITE #103
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-2436
Practice Address - Country:US
Practice Address - Phone:615-331-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5915513OtherAETNA - NON HMO
TN621805796OtherPHCS
TN2247015OtherAETNA - HMO
TN3139529OtherBLUE CROSS BLUE SHIELD
TN3970350Medicare ID - Type Unspecified