Provider Demographics
NPI:1518169937
Name:BRINKMAN, JAY WARREN (DC)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:WARREN
Last Name:BRINKMAN
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 1:510 E SEYMOUR ST
Mailing Address - Street 2:
Mailing Address - City:KENTLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47951-1240
Mailing Address - Country:US
Mailing Address - Phone:219-474-5066
Mailing Address - Fax:219-474-5066
Practice Address - Street 1:510 E SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:KENTLAND
Practice Address - State:IN
Practice Address - Zip Code:47951-1240
Practice Address - Country:US
Practice Address - Phone:219-474-5066
Practice Address - Fax:219-474-5066
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000927A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor