Provider Demographics
NPI:1013953363
Name:TOLMAN, BRIAN W (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:W
Last Name:TOLMAN
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 1:4645 SOUTH MIDLAND DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WEST HAVEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-9507
Mailing Address - Country:US
Mailing Address - Phone:801-731-9899
Mailing Address - Fax:
Practice Address - Street 1:4645 SOUTH MIDLAND DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:WEST HAVEN
Practice Address - State:UT
Practice Address - Zip Code:84401-9507
Practice Address - Country:US
Practice Address - Phone:801-731-9899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5256286-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU95524Medicare UPIN
005729101Medicare ID - Type Unspecified