Provider Demographics
NPI:1700067196
Name:BORST, BRENDA J (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:J
Last Name:BORST
Suffix:
Gender:F
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:PO BOX 470
Mailing Address - Street 2:100 CORRY STREET
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387-0470
Mailing Address - Country:US
Mailing Address - Phone:937-767-2733
Mailing Address - Fax:937-767-2736
Practice Address - Street 1:100 CORRY ST
Practice Address - Street 2:
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-1809
Practice Address - Country:US
Practice Address - Phone:937-767-2733
Practice Address - Fax:937-767-2736
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2055716Medicaid
OH0842481Medicare PIN