MEDICARE: MR. BRIAN JAMES PLESHA 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	001766	MN

General Provider Information

NPI Number	:	1265439061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN JAMES PLESHA DC

Provider Business Mailing Address
First Line	:	PO BOX 484
Second Line	:
City	:	VIRGINIA
State	:	MN
Zip	:	55792-0484
Country	:	US
Telephone Number	:	218-749-6287
Fax Number	:	218-749-6288

Provider Business Practice Location Address
First Line	:	305 CHESTNUT ST
Second Line	:
City	:	VIRGINIA
State	:	MN
Zip	:	55792-2523
Country	:	US
Telephone Number	:	218-749-6287
Fax Number	:	218-749-6288

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	06/09/2011

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