Provider Demographics
NPI:1497893424
Name:MCDONOUGH, BRETT RUSSELL (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:RUSSELL
Last Name:MCDONOUGH
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 1:1444 NW 124TH CT
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8150
Mailing Address - Country:US
Mailing Address - Phone:515-278-2782
Mailing Address - Fax:515-278-0194
Practice Address - Street 1:1444 NW 124TH CT
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8150
Practice Address - Country:US
Practice Address - Phone:515-278-2782
Practice Address - Fax:515-278-0194
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007055111N00000X
WI4286-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor