Provider Demographics
NPI:1780948174
Name:BRIAN HERLINE CHIROPRACTIC INC
Entity type:Organization
Organization Name:BRIAN HERLINE CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-527-8560
Mailing Address - Street 1:2150 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4402
Mailing Address - Country:US
Mailing Address - Phone:209-527-8560
Mailing Address - Fax:
Practice Address - Street 1:2150 SCENIC DR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4402
Practice Address - Country:US
Practice Address - Phone:209-527-8560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0174130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty