Provider Demographics
NPI:1790712032
Name:BRIMHALL, BRETT BRIAN (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:BRIAN
Last Name:BRIMHALL
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 E BASELINE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2728
Mailing Address - Country:US
Mailing Address - Phone:480-964-5107
Mailing Address - Fax:480-964-5234
Practice Address - Street 1:3303 E BASELINE RD STE 204
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2728
Practice Address - Country:US
Practice Address - Phone:480-964-5107
Practice Address - Fax:480-964-5234
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ65424Medicare PIN