Provider Demographics
NPI:1689613655
Name:BRIAN M. MCCOURT D.B.A. MCCOURT CHIROPRACTIC
Entity Type:Organization
Organization Name:BRIAN M. MCCOURT D.B.A. MCCOURT CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-675-4333
Mailing Address - Street 1:3681 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3452
Mailing Address - Country:US
Mailing Address - Phone:716-675-4333
Mailing Address - Fax:716-677-0871
Practice Address - Street 1:3681 SENECA ST
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3452
Practice Address - Country:US
Practice Address - Phone:716-675-4333
Practice Address - Fax:716-677-0871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009974-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU89131Medicare UPIN