Provider Demographics
NPI:1124167101
Name:NEIDENTHAL, BRIAN KENNETH (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:KENNETH
Last Name:NEIDENTHAL
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 1:500 CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-2109
Mailing Address - Country:US
Mailing Address - Phone:614-560-0661
Mailing Address - Fax:
Practice Address - Street 1:5151 POST RD
Practice Address - Street 2:SUITE 150
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1245
Practice Address - Country:US
Practice Address - Phone:614-798-9600
Practice Address - Fax:614-798-0021
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU88994Medicare UPIN
OHNE4069441Medicare ID - Type Unspecified