Provider Demographics
NPI:1407839020
Name:WIRICK, BRIAN EUGENE (DC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:EUGENE
Last Name:WIRICK
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 1:813 W NAPA ST
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6414
Mailing Address - Country:US
Mailing Address - Phone:707-935-4330
Mailing Address - Fax:707-935-4333
Practice Address - Street 1:813 W NAPA ST
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6414
Practice Address - Country:US
Practice Address - Phone:707-935-4330
Practice Address - Fax:707-935-4333
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19651111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0196510Medicare ID - Type Unspecified