Provider Demographics
NPI:1366447245
Name:SCOLARI, BRIAN ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ANTHONY
Last Name:SCOLARI
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 1:54989 SHELBY RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-1448
Mailing Address - Country:US
Mailing Address - Phone:248-656-7194
Mailing Address - Fax:248-656-7195
Practice Address - Street 1:54989 SHELBY RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-1448
Practice Address - Country:US
Practice Address - Phone:248-656-7194
Practice Address - Fax:248-656-7195
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2012-12-12
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
MI2301008199111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON92080Medicare PIN