Provider Demographics
NPI:1568521110
Name:OWEN, BRIAN J (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:OWEN
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 1:5301 LONGLEY LN
Mailing Address - Street 2:STE. 43
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1805
Mailing Address - Country:US
Mailing Address - Phone:775-829-8686
Mailing Address - Fax:
Practice Address - Street 1:5301 LONGLEY LN
Practice Address - Street 2:STE. 43
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1805
Practice Address - Country:US
Practice Address - Phone:775-829-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV100262Medicare PIN
V100261Medicare PIN
V03851Medicare UPIN