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General NPI Number Information
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NPI Number | 1356434369
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Entity Type | Individual
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Provider Name | BRENT M MUSOLF D.C.
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 305 E HURON AVE STE 9
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City | BAD AXE
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State | MI
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Zip | 48413-1448
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Country | US
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Telephone | 989-269-7300
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Fax | 989-269-7303
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Provider Business Mailing Address
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Address Line | 3159 SHORE DR
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City | PORT AUSTIN
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State | MI
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Zip | 48467-9726
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Country | US
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Telephone | 989-975-0062
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301008010
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License Number State | MI
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