Provider Demographics
NPI:1669706370
Name:WARNER, BRENT J (DC)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:J
Last Name:WARNER
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 1:11515 SW DURHAM RD STE E9
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-3476
Mailing Address - Country:US
Mailing Address - Phone:503-960-9929
Mailing Address - Fax:503-597-1096
Practice Address - Street 1:11515 SW DURHAM RD STE E9
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-3476
Practice Address - Country:US
Practice Address - Phone:503-960-9929
Practice Address - Fax:503-597-1096
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor