MEDICARE: MARK W. BRISBY D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	19063DC	CA

General Provider Information

NPI Number	:	1053310748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK W. BRISBY D.C.

Provider Business Mailing Address
First Line	:	5638 HOLLISTER AVE STE 301
Second Line	:
City	:	GOLETA
State	:	CA
Zip	:	93117-3474
Country	:	US
Telephone Number	:	805-681-7273
Fax Number	:	805-681-7253

Provider Business Practice Location Address
First Line	:	5638 HOLLISTER AVE
Second Line	:	STE 301
City	:	GOLETA
State	:	CA
Zip	:	93117-3474
Country	:	US
Telephone Number	:	805-681-7273
Fax Number	:	805-681-7253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	01/08/2008

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