Provider Demographics
NPI:1568499580
Name:DORNBUSH, BRIAN R (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:R
Last Name:DORNBUSH
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 1:1001 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-3403
Mailing Address - Country:US
Mailing Address - Phone:563-242-9343
Mailing Address - Fax:563-242-8507
Practice Address - Street 1:1001 13TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-3403
Practice Address - Country:US
Practice Address - Phone:563-242-9343
Practice Address - Fax:563-242-8507
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06166111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2180513Medicaid
IAU72990Medicare UPIN
IAI4266Medicare ID - Type Unspecified