Provider Demographics
NPI:1497840102
Name:ORMOND, BRIAN M (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:ORMOND
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 1:353 SPROWEL CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:GARBERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95542
Mailing Address - Country:US
Mailing Address - Phone:707-923-9343
Mailing Address - Fax:
Practice Address - Street 1:353 SPROWEL CREEK ROAD
Practice Address - Street 2:
Practice Address - City:GARBERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95542
Practice Address - Country:US
Practice Address - Phone:707-923-9343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0167910Medicare ID - Type Unspecified