Healthcare Provider Details

I. General information

NPI: 1497221824
Provider Name (Legal Business Name): BRIAN LOUIS REGAN DC, MS, ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2458 CHERRY ST
DUBUQUE IA
52001-5749
US

IV. Provider business mailing address

4840 ASBURY RD STE 102
DUBUQUE IA
52002-0480
US

V. Phone/Fax

Practice location:
  • Phone: 563-599-1280
  • Fax:
Mailing address:
  • Phone: 563-845-0033
  • Fax: 563-845-0000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number093105
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number001022
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: