Provider Demographics
NPI:1700329760
Name:GORE, BRIAN RUSSELL (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:RUSSELL
Last Name:GORE
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 1:1400 BECKETT ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-8302
Mailing Address - Country:US
Mailing Address - Phone:512-264-4801
Mailing Address - Fax:
Practice Address - Street 1:1000 E 41ST ST
Practice Address - Street 2:#915
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-4808
Practice Address - Country:US
Practice Address - Phone:512-359-3205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor