MEDICARE: BRIAN J BROST 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	3358	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	141964862012	OTHER	WI	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427058700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN J BROST DC

Provider Business Mailing Address
First Line	:	PO BOX 66
Second Line	:	237 W BROADWAY
City	:	BLAIR
State	:	WI
Zip	:	54616-0066
Country	:	US
Telephone Number	:	608-989-2020
Fax Number	:	608-989-2308

Provider Business Practice Location Address
First Line	:	237 W BROADWAY ST
Second Line	:
City	:	BLAIR
State	:	WI
Zip	:	54616-9366
Country	:	US
Telephone Number	:	608-989-2020
Fax Number	:	608-989-2308

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/08/2007

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