Provider Demographics
NPI:1922157155
Name:FLAKE, BRIAN VERN (DC LMP)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:VERN
Last Name:FLAKE
Suffix:
Gender:M
Credentials:DC LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 W GARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2955
Mailing Address - Country:US
Mailing Address - Phone:509-924-1942
Mailing Address - Fax:509-924-0615
Practice Address - Street 1:608 W GARLAND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2955
Practice Address - Country:US
Practice Address - Phone:509-924-1942
Practice Address - Fax:509-924-0615
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACHOOO34249111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA602 355 363Medicare UPIN
WAG8801717Medicare ID - Type UnspecifiedCHIROPRACTIC