MEDICARE: MR. BRIAN EUGENE WIRICK 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	DC19651	CA

General Provider Information

NPI Number	:	1407839020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN EUGENE WIRICK DC

Provider Business Mailing Address
First Line	:	813 W NAPA ST
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-6414
Country	:	US
Telephone Number	:	707-935-4330
Fax Number	:	707-935-4333

Provider Business Practice Location Address
First Line	:	813 W NAPA ST
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-6414
Country	:	US
Telephone Number	:	707-935-4330
Fax Number	:	707-935-4333

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	07/25/2013

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