MEDICARE: DR. MARK EUGENE BREWER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2026	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003812991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK EUGENE BREWER DC

Provider Business Mailing Address
First Line	:	3800 SHORELINE DR
Second Line	:
City	:	WAYZATA
State	:	MN
Zip	:	55391-9785
Country	:	US
Telephone Number	:	952-471-2555
Fax Number	:	952-471-2556

Provider Business Practice Location Address
First Line	:	3800 SHORELINE DR
Second Line	:
City	:	WAYZATA
State	:	MN
Zip	:	55391-9785
Country	:	US
Telephone Number	:	952-471-2555
Fax Number	:	952-471-2556

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	04/27/2011

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Directions to “ DR. MARK EUGENE BREWER DC” Practice Location

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