Provider Demographics
NPI:1356492417
Name:ANTHONY, BRETT A (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:A
Last Name:ANTHONY
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 1:308 S SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-4501
Mailing Address - Country:US
Mailing Address - Phone:574-269-4900
Mailing Address - Fax:574-269-4940
Practice Address - Street 1:308 S SCOTT ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-4501
Practice Address - Country:US
Practice Address - Phone:574-269-4900
Practice Address - Fax:574-269-4940
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002039A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN199840Medicare ID - Type Unspecified
INP00268584Medicare ID - Type UnspecifiedRAILROAD MEDICARE