Provider Demographics
NPI:1912004227
Name:MEINBURG, BRENT I (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:I
Last Name:MEINBURG
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 1:4290 MILLER RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1283
Mailing Address - Country:US
Mailing Address - Phone:810-230-5500
Mailing Address - Fax:810-230-2895
Practice Address - Street 1:4290 MILLER RD
Practice Address - Street 2:SUITE 6
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1283
Practice Address - Country:US
Practice Address - Phone:810-230-5500
Practice Address - Fax:810-230-2895
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBM008963111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIV07078Medicare UPIN