Provider Demographics
NPI:1508940859
Name:SYMES, BRENT (DC)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:SYMES
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 1:20 N FISHER PARK WAY
Mailing Address - Street 2:STE 100
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-4709
Mailing Address - Country:US
Mailing Address - Phone:425-712-9277
Mailing Address - Fax:
Practice Address - Street 1:20 N FISHER PARK WAY
Practice Address - Street 2:STE 100
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-4709
Practice Address - Country:US
Practice Address - Phone:425-712-9277
Practice Address - Fax:425-775-5085
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-2062111N00000X
WACH00034584111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
3853SYOtherREGENCE BLUESHIELD RIDER
0213787OtherLABOR AND INDUSTRIES
8862121Medicare PIN