Provider Demographics
NPI:1417942145
Name:MENZIES, BRIAN R (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:R
Last Name:MENZIES
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 1:2589 FAIRMONT AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-3442
Mailing Address - Country:US
Mailing Address - Phone:801-918-9025
Mailing Address - Fax:
Practice Address - Street 1:2589 FAIRMONT AVE
Practice Address - Street 2:SUITE C
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-3442
Practice Address - Country:US
Practice Address - Phone:304-333-6668
Practice Address - Fax:304-333-6666
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2008-06-25
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-08-07
Provider Licenses
StateLicense IDTaxonomies
WV833111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
4174921Medicare PIN