Provider Demographics
NPI:1619910452
Name:HUSER, BRENDA J (DC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:HUSER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 ACE DR
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-1327
Mailing Address - Country:US
Mailing Address - Phone:859-985-0606
Mailing Address - Fax:859-985-0052
Practice Address - Street 1:1048 ACE DR
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1327
Practice Address - Country:US
Practice Address - Phone:859-985-0606
Practice Address - Fax:859-985-0052
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO4733111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY710013810Medicaid
KY0976601Medicare PIN