Provider Demographics
NPI:1265508873
Name:DOVORANY, BRIAN THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:THOMAS
Last Name:DOVORANY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:163 N BROADWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-2727
Mailing Address - Country:US
Mailing Address - Phone:920-437-3370
Mailing Address - Fax:920-437-6212
Practice Address - Street 1:2031 S WEBSTER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2257
Practice Address - Country:US
Practice Address - Phone:920-437-3370
Practice Address - Fax:920-437-6212
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI75681Medicare ID - Type Unspecified
WIU65820Medicare UPIN