MEDICARE: DR. JOHN H BRICKLEY 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	1708	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51026361	OTHER	AL	PROVIDER ID

General Provider Information

NPI Number	:	1538200365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN H BRICKLEY D.C.

Provider Business Mailing Address
First Line	:	1215 FOREST AVE NW
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-3035
Country	:	US
Telephone Number	:	256-845-4478
Fax Number	:	256-845-4478

Provider Business Practice Location Address
First Line	:	1215 FOREST AVE NW
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-3035
Country	:	US
Telephone Number	:	256-845-4478
Fax Number	:	256-845-4478

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	02/24/2012

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