Provider Demographics
NPI:1699210013
Name:MEEUWENBERG, BRIEANN
Entity Type:Individual
Prefix:
First Name:BRIEANN
Middle Name:
Last Name:MEEUWENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-1624
Mailing Address - Country:US
Mailing Address - Phone:231-924-3456
Mailing Address - Fax:
Practice Address - Street 1:106 S STEWART AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-1624
Practice Address - Country:US
Practice Address - Phone:231-924-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010497111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor