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General NPI Number Information
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NPI Number | 1649462672
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Entity Type | Organization
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Legal Business Name | BRIAN J ANSEEUW M.D. S.C.
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 616 35TH AVE UNIT 2
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City | MOLINE
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State | IL
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Zip | 61265-5925
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Country | US
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Telephone | 309-764-4729
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Fax | 309-764-7144
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Provider Business Mailing Address
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Address Line | 616 35TH AVE SUITE 2
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City | MOLINE
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State | IL
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Zip | 61265-6158
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Country | US
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Telephone | 309-764-4729
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Fax | 309-764-7144
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN JAY ANSEEUW
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Credential | M.D.
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Telephone | 309-764-4729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 042618374
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License Number State | IL
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