Provider Demographics
NPI:1417058876
Name:DEVALLIERE, BRIAN MITCHELL (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MITCHELL
Last Name:DEVALLIERE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MITCHELL
Other - Middle Name:
Other - Last Name:DEVALLIERE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:595 MT ROSE ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3363
Mailing Address - Country:US
Mailing Address - Phone:775-323-3660
Mailing Address - Fax:775-323-6852
Practice Address - Street 1:595 MT ROSE ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509
Practice Address - Country:US
Practice Address - Phone:775-323-3660
Practice Address - Fax:775-323-6852
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00395111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV38038Medicare ID - Type Unspecified