Provider Demographics
NPI:1548404007
Name:CORNISH, BRETT ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ALLEN
Last Name:CORNISH
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 1:1911 4TH ST SW
Mailing Address - Street 2:SUITE C
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-4619
Mailing Address - Country:US
Mailing Address - Phone:641-201-1028
Mailing Address - Fax:
Practice Address - Street 1:1911 4TH ST SW
Practice Address - Street 2:SUITE C
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-4619
Practice Address - Country:US
Practice Address - Phone:641-201-1028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007195111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor