Provider Demographics
NPI:1740233931
Name:COTTER, BRYAN J (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:J
Last Name:COTTER
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 3393
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02304-3393
Mailing Address - Country:US
Mailing Address - Phone:508-427-0008
Mailing Address - Fax:508-427-0009
Practice Address - Street 1:953 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-6681
Practice Address - Country:US
Practice Address - Phone:508-427-0008
Practice Address - Fax:508-427-0009
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACO Y45717Medicare ID - Type Unspecified