Provider Demographics
NPI:1881807444
Name:BRIAN ANTHONY CHIROPRACTIC INC
Entity type:Organization
Organization Name:BRIAN ANTHONY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:831-479-0255
Mailing Address - Street 1:3051 PORTER ST
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2233
Mailing Address - Country:US
Mailing Address - Phone:831-479-0255
Mailing Address - Fax:831-479-9138
Practice Address - Street 1:3051 PORTER ST
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2233
Practice Address - Country:US
Practice Address - Phone:831-479-0255
Practice Address - Fax:831-479-9138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0137320Medicare UPIN