Provider Demographics
NPI:1265439061
Name:PLESHA, BRIAN JAMES (DC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JAMES
Last Name:PLESHA
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:PO BOX 484
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-0484
Mailing Address - Country:US
Mailing Address - Phone:218-749-6287
Mailing Address - Fax:218-749-6288
Practice Address - Street 1:305 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2523
Practice Address - Country:US
Practice Address - Phone:218-749-6287
Practice Address - Fax:218-749-6288
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN001766111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350001362Medicare ID - Type Unspecified
T66011Medicare UPIN