Provider Demographics
NPI:1447747795
Name:COUSINEAU, BRIANNA (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:
Last Name:COUSINEAU
Suffix:
Gender:F
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:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:CAPAC
Mailing Address - State:MI
Mailing Address - Zip Code:48014-0159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4260 M-53
Practice Address - Street 2:SUITE 110
Practice Address - City:ALMONT
Practice Address - State:MI
Practice Address - Zip Code:48003
Practice Address - Country:US
Practice Address - Phone:810-673-3044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-21
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty