Provider Demographics
NPI:1013940550
Name:BRICE, CAL RENARD (DC)
Entity Type:Individual
Prefix:DR
First Name:CAL
Middle Name:RENARD
Last Name:BRICE
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 1:1125 DRUID PARK AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5849
Mailing Address - Country:US
Mailing Address - Phone:706-736-5551
Mailing Address - Fax:706-736-5933
Practice Address - Street 1:1125 DRUID PARK AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5849
Practice Address - Country:US
Practice Address - Phone:706-736-5551
Practice Address - Fax:706-736-5933
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2573Medicaid
GA35ZCBCSMedicare UPIN