Provider Demographics
NPI:1407944036
Name:PIATAK, BRIAN JOHN (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JOHN
Last Name:PIATAK
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 1:30 N SCOTT STREET
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407
Mailing Address - Country:US
Mailing Address - Phone:570-282-5464
Mailing Address - Fax:570-282-5349
Practice Address - Street 1:30 N SCOTT STREET
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407
Practice Address - Country:US
Practice Address - Phone:570-282-5464
Practice Address - Fax:570-282-5349
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007832L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1833299Medicaid
670493OtherBLUE CROSS
818422OtherFIRST PRIORITY
PAPI043474Medicare ID - Type Unspecified
670493OtherBLUE CROSS