Provider Demographics
NPI:1659349090
Name:COLEMAN, BRIAN DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DAVID
Last Name:COLEMAN
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 1:2501 FERRAND ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3210
Mailing Address - Country:US
Mailing Address - Phone:318-388-2215
Mailing Address - Fax:318-388-5395
Practice Address - Street 1:2501 FERRAND ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3210
Practice Address - Country:US
Practice Address - Phone:318-388-2215
Practice Address - Fax:318-388-5395
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA535111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CN64Medicare UPIN
LA59191CN64Medicare ID - Type Unspecified