Provider Demographics
NPI:1568408482
Name:DOUGLAS, BRIAN JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JAMES
Last Name:DOUGLAS
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 1:180 STATE RD
Mailing Address - Street 2:SUITE 2L
Mailing Address - City:SAGAMORE BEACH
Mailing Address - State:MA
Mailing Address - Zip Code:02562-2362
Mailing Address - Country:US
Mailing Address - Phone:508-888-3949
Mailing Address - Fax:508-888-3910
Practice Address - Street 1:180 STATE RD
Practice Address - Street 2:SUITE 2L
Practice Address - City:SAGAMORE BEACH
Practice Address - State:MA
Practice Address - Zip Code:02562-2362
Practice Address - Country:US
Practice Address - Phone:508-888-3949
Practice Address - Fax:508-888-3910
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor