Provider Demographics
NPI:1386871986
Name:SANBORN, BRIAN ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ALAN
Last Name:SANBORN
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 1:5979 E BROADWAY RD # 101
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-7991
Mailing Address - Country:US
Mailing Address - Phone:989-775-3155
Mailing Address - Fax:989-772-1286
Practice Address - Street 1:5979 E BROADWAY RD # 101
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-7991
Practice Address - Country:US
Practice Address - Phone:989-775-3155
Practice Address - Fax:989-772-1286
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005440111NI0900X, 111NN0400X
MI23201005440111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111NI0900XChiropractic ProvidersChiropractorInternist
No111NN1001XChiropractic ProvidersChiropractorNutrition