Provider Demographics
NPI:1508923822
Name:MCMASTER, BRIAN DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DAVID
Last Name:MCMASTER
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 1:930 LILA AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-1683
Mailing Address - Country:US
Mailing Address - Phone:513-248-1040
Mailing Address - Fax:513-248-1033
Practice Address - Street 1:930 LILA AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-1683
Practice Address - Country:US
Practice Address - Phone:513-248-1040
Practice Address - Fax:513-248-1033
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
31-1393036OtherFEDERAL TAX IDENTIFICATIO
31-1393036OtherFEDERAL TAX IDENTIFICATIO