MEDICARE: DR. BRIAN W TOLMAN D.C.

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	5256286-1202	UT

General Provider Information

NPI Number	:	1013953363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN W TOLMAN D.C.

Provider Business Mailing Address
First Line	:	4645 SOUTH MIDLAND DRIVE
Second Line	:	SUITE 2
City	:	WEST HAVEN
State	:	UT
Zip	:	84401-9507
Country	:	US
Telephone Number	:	801-731-9899
Fax Number	:

Provider Business Practice Location Address
First Line	:	4645 SOUTH MIDLAND DRIVE
Second Line	:	SUITE 2
City	:	WEST HAVEN
State	:	UT
Zip	:	84401-9507
Country	:	US
Telephone Number	:	801-731-9899
Fax Number	:

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/10/2008

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