Provider Demographics
NPI:1578664447
Name:BEGRES, BRIAN (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:BEGRES
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 1:918 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-3452
Mailing Address - Country:US
Mailing Address - Phone:906-774-4980
Mailing Address - Fax:906-774-9698
Practice Address - Street 1:918 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3452
Practice Address - Country:US
Practice Address - Phone:906-774-4980
Practice Address - Fax:906-774-9698
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBB008830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIV04026Medicare UPIN
MIM80040003Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL