Provider Demographics
NPI:1396828802
Name:BRILL, ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:BRILL
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 1:9566 STATE HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-9054
Mailing Address - Country:US
Mailing Address - Phone:715-356-6095
Mailing Address - Fax:
Practice Address - Street 1:9566 STATE HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-9054
Practice Address - Country:US
Practice Address - Phone:715-356-6095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1721 - 012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38776400Medicaid
WI000075614Medicare PIN