Provider Demographics
NPI:1770648305
Name:SHORT, BRIAN T (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:T
Last Name:SHORT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1444 S SAINT FRANCIS DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4229
Mailing Address - Country:US
Mailing Address - Phone:505-660-2080
Mailing Address - Fax:505-983-7554
Practice Address - Street 1:1444 S SAINT FRANCIS DR
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4229
Practice Address - Country:US
Practice Address - Phone:505-660-2080
Practice Address - Fax:505-983-7554
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM1538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM043814567OtherUNITED HLTHCARE PROV ID
NM043814567OtherLOVELACE PROVIDER ID
NM04-3814567OtherSTATE TAX ID
NM043814567OtherCIGNA PROVIDER ID
NMNM00KL90OtherBCBS PROVIDER ID
NM04-3814567OtherSTATE TAX ID