Provider Demographics
NPI:1750593364
Name:BRIAN C. SOLOMON
Entity type:Organization
Organization Name:BRIAN C. SOLOMON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOUL PROPRIETOR TREATING DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-789-2602
Mailing Address - Street 1:751 PRE EMPTION RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1335
Mailing Address - Country:US
Mailing Address - Phone:315-789-2602
Mailing Address - Fax:315-781-3288
Practice Address - Street 1:751 PRE EMPTION RD
Practice Address - Street 2:SUITE 3
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1335
Practice Address - Country:US
Practice Address - Phone:315-789-2602
Practice Address - Fax:315-781-3288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009981-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPO10009981OtherBLUE CROSS BLUE SHIELD
NYC09987-4WOtherWORKERS COMP
NYPO10109981OtherBLUE CHOICE
NYC09987-4WOtherWORKERS COMP
NYBA0520Medicare ID - Type UnspecifiedMEDICARE
NYPO10109981OtherBLUE CHOICE