Provider Demographics
NPI:1063546604
Name:WHITFIELD, BRIAN THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:THOMAS
Last Name:WHITFIELD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3311
Mailing Address - Country:US
Mailing Address - Phone:508-747-2722
Mailing Address - Fax:508-747-1499
Practice Address - Street 1:29 NORTH ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-8310
Practice Address - Country:US
Practice Address - Phone:508-747-2722
Practice Address - Fax:508-747-1499
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA676111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA35030OtherHPHC
MAY35467OtherBCBS
MA35030OtherHPHC