Healthcare Provider Details

I. General information

NPI: 1417942145
Provider Name (Legal Business Name): BRIAN R MENZIES DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date: 03/23/2006
Reactivation Date: 08/07/2006

III. Provider practice location address

2589 FAIRMONT AVE SUITE C
FAIRMONT WV
26554-3442
US

IV. Provider business mailing address

2589 FAIRMONT AVE SUITE C
FAIRMONT WV
26554-3442
US

V. Phone/Fax

Practice location:
  • Phone: 304-333-6668
  • Fax: 304-333-6666
Mailing address:
  • Phone: 801-918-9025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number833
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: