Provider Demographics
NPI:1710190467
Name:MOUCH, BRIAN ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ROBERT
Last Name:MOUCH
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 1:6010 WOOSTER PIKE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-4207
Mailing Address - Country:US
Mailing Address - Phone:513-271-4849
Mailing Address - Fax:513-271-4859
Practice Address - Street 1:6010 WOOSTER PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-4207
Practice Address - Country:US
Practice Address - Phone:513-271-4849
Practice Address - Fax:513-271-4859
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1584111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH31132568500OtherBUREAU OF WORKERS COMPENS
OH31132568500OtherBUREAU OF WORKERS COMPENS