MEDICARE: DR. LAINA BEARD BRILLIANT DC

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	6621	CO

General Provider Information

NPI Number	:	1376821496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAINA BEARD BRILLIANT DC

Provider Business Mailing Address
First Line	:	1241 S PARKER RD
Second Line	:	SUITE 200
City	:	DENVER
State	:	CO
Zip	:	80231-2159
Country	:	US
Telephone Number	:	303-745-6666
Fax Number	:	303-745-4599

Provider Business Practice Location Address
First Line	:	1241 S PARKER RD
Second Line	:	SUITE 200
City	:	DENVER
State	:	CO
Zip	:	80231-2159
Country	:	US
Telephone Number	:	303-745-6666
Fax Number	:	303-745-4599

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

Provider Enumeration Date	:	07/22/2011
Last Update Date	:	07/22/2011

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