Provider Demographics
NPI:1578621041
Name:COUNSELMAN, BRETT LEE (DC)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:LEE
Last Name:COUNSELMAN
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 1:1408 SW TOPEKA BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66612-1819
Mailing Address - Country:US
Mailing Address - Phone:785-234-0521
Mailing Address - Fax:785-234-2405
Practice Address - Street 1:1408 SW TOPEKA BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66612-1819
Practice Address - Country:US
Practice Address - Phone:785-234-0521
Practice Address - Fax:785-234-2405
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS62331OtherBCBS PROVIDER NUMBER