Provider Demographics
NPI:1609950864
Name:CIVINSKI, BRIAN FRANCIS (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:FRANCIS
Last Name:CIVINSKI
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 1:3105 NOTTINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1844
Mailing Address - Country:US
Mailing Address - Phone:609-631-7200
Mailing Address - Fax:609-631-9363
Practice Address - Street 1:3105 NOTTINGHAM WAY
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1844
Practice Address - Country:US
Practice Address - Phone:609-631-7200
Practice Address - Fax:609-631-9363
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC00516500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U94248Medicare UPIN
067831Medicare ID - Type Unspecified