Provider Demographics
NPI:1699856807
Name:HUSSKE, BRIAN A (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:A
Last Name:HUSSKE
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:PO BOX 864
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-0864
Mailing Address - Country:US
Mailing Address - Phone:307-674-7433
Mailing Address - Fax:
Practice Address - Street 1:1265 COFFEEN AVENUE
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801
Practice Address - Country:US
Practice Address - Phone:307-674-7433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY303549OtherBLUE CROSS BLUE SHIELD
WY303549OtherBLUE CROSS BLUE SHIELD
WYU12082Medicare UPIN