Provider Demographics
NPI:1669619995
Name:BRICKNER CHIROPRACTIC HEALTH CENTER, INC.
Entity type:Organization
Organization Name:BRICKNER CHIROPRACTIC HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRICKNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-748-4533
Mailing Address - Street 1:20 ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-1135
Mailing Address - Country:US
Mailing Address - Phone:937-748-4533
Mailing Address - Fax:937-748-4599
Practice Address - Street 1:20 ROYAL DR
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-1135
Practice Address - Country:US
Practice Address - Phone:937-748-4533
Practice Address - Fax:937-748-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1497261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0657682OtherMEDICARE ID - TYPE UNSPECIFIED
OHU10950Medicare UPIN