Provider Demographics
NPI:1740474949
Name:DOUGLAS P BRISSON PC
Entity type:Organization
Organization Name:DOUGLAS P BRISSON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BRISSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-678-8489
Mailing Address - Street 1:639 KEN PRATT BLVD
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6419
Mailing Address - Country:US
Mailing Address - Phone:303-678-8489
Mailing Address - Fax:303-678-8542
Practice Address - Street 1:639 KEN PRATT BLVD
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6419
Practice Address - Country:US
Practice Address - Phone:303-678-8489
Practice Address - Fax:303-678-8542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2270111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO805139Medicare UPIN