Provider Demographics
NPI:1649330770
Name:BRIEN, MITCHELL PAUL
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:PAUL
Last Name:BRIEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 698
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70047-0698
Mailing Address - Country:US
Mailing Address - Phone:985-331-8007
Mailing Address - Fax:985-331-8003
Practice Address - Street 1:13601 RIVER RD
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-4264
Practice Address - Country:US
Practice Address - Phone:985-331-8007
Practice Address - Fax:985-331-8003
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor