Provider Demographics
NPI:1689208720
Name:BRICKEY CHIROPRACTIC AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:BRICKEY CHIROPRACTIC AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-358-4157
Mailing Address - Street 1:4139 MEXICO RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6410
Mailing Address - Country:US
Mailing Address - Phone:636-358-4157
Mailing Address - Fax:
Practice Address - Street 1:4139 MEXICO RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6410
Practice Address - Country:US
Practice Address - Phone:636-358-4157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty