Provider Demographics
NPI:1457661126
Name:MEHAFFEY, BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:MEHAFFEY
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 1:4357 OAK HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7101
Mailing Address - Country:US
Mailing Address - Phone:802-343-5001
Mailing Address - Fax:
Practice Address - Street 1:4357 OAK HILL ROAD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7101
Practice Address - Country:US
Practice Address - Phone:802-343-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5698111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor