Provider Demographics
NPI:1982760609
Name:BREAU, CHRISTY GARDE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:GARDE
Last Name:BREAU
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:RENE
Other - Last Name:GARDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:412 NW MOCK AVE
Mailing Address - Street 2:STE A
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2511
Mailing Address - Country:US
Mailing Address - Phone:816-224-3440
Mailing Address - Fax:816-224-3442
Practice Address - Street 1:412 NW MOCK AVE
Practice Address - Street 2:STE A
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2511
Practice Address - Country:US
Practice Address - Phone:816-224-3440
Practice Address - Fax:816-224-3442
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26419029OtherBCBS PROVIDER NUMBER
MO7081050OtherAETNA PROVIDER NUMBER