Healthcare Provider Details

I. General information

NPI: 1740626209
Provider Name (Legal Business Name): JOHN WAYNE BRIMHALL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10281 RANCHO MONTECITO DR
PARKER CO
80138
US

IV. Provider business mailing address

10281 RANCHO MONTECITO DR
PARKER CO
80138
US

V. Phone/Fax

Practice location:
  • Phone: 602-538-0976
  • Fax: 720-851-5319
Mailing address:
  • Phone: 602-538-0976
  • Fax: 720-851-5319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2098
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: