Provider Demographics
NPI:1497221824
Name:REGAN, BRIAN LOUIS (DC, MS, ATC, CSCS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LOUIS
Last Name:REGAN
Suffix:
Gender:M
Credentials:DC, MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 ASBURY RD
Mailing Address - Street 2:STE 102
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-0480
Mailing Address - Country:US
Mailing Address - Phone:563-845-0033
Mailing Address - Fax:563-845-0000
Practice Address - Street 1:2458 CHERRY ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-5749
Practice Address - Country:US
Practice Address - Phone:563-599-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0010222255A2300X
IA093105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer