Provider Demographics
NPI:1184813743
Name:BRIMHALL, EZEKIEL B (DC)
Entity type:Individual
Prefix:
First Name:EZEKIEL
Middle Name:B
Last Name:BRIMHALL
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 1:6610 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-5124
Mailing Address - Country:US
Mailing Address - Phone:505-324-1111
Mailing Address - Fax:505-324-1111
Practice Address - Street 1:6610 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-5124
Practice Address - Country:US
Practice Address - Phone:505-324-1111
Practice Address - Fax:505-324-1111
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor