Provider Demographics
NPI:1649588641
Name:MASSIMINI, BRIAN (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:MASSIMINI
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 1:660 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18844-7850
Mailing Address - Country:US
Mailing Address - Phone:570-965-2998
Mailing Address - Fax:570-965-2998
Practice Address - Street 1:242 NOBLE RD
Practice Address - Street 2:
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-9406
Practice Address - Country:US
Practice Address - Phone:570-586-1411
Practice Address - Fax:570-965-2998
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010314111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor