Provider Demographics
NPI:1376247957
Name:C'HAIR, BRIAN DALE SR
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DALE
Last Name:C'HAIR
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 N 12TH ST E
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-3805
Mailing Address - Country:US
Mailing Address - Phone:307-856-9281
Mailing Address - Fax:
Practice Address - Street 1:511 N 12TH ST E
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-3805
Practice Address - Country:US
Practice Address - Phone:307-856-9281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist