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General NPI Number Information
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NPI Number | 1497221824
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Entity Type | Individual
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Provider Name | BRIAN LOUIS REGAN DC, MS, ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 10/24/2018
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 2458 CHERRY ST
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City | DUBUQUE
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State | IA
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Zip | 52001-5749
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Country | US
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Telephone | 563-599-1280
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Fax |
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Provider Business Mailing Address
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Address Line | 4840 ASBURY RD STE 102
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City | DUBUQUE
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State | IA
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Zip | 52002-0480
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Country | US
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Telephone | 563-845-0033
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Fax | 563-845-0000
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 001022
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 093105
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License Number State | IA
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