Provider Demographics
NPI:1518003979
Name:BRINK, JUSTIN P (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:P
Last Name:BRINK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:393 W RIVER TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7124
Mailing Address - Country:US
Mailing Address - Phone:408-410-4808
Mailing Address - Fax:208-563-3938
Practice Address - Street 1:36 N ECHOHAWK LN STE 104B
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-4013
Practice Address - Country:US
Practice Address - Phone:208-968-6700
Practice Address - Fax:208-563-3938
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30461111N00000X, 111NR0400X, 111NS0005X
IDCHIA-2248111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician