Provider Demographics
NPI:1427058700
Name:BROST, BRIAN J (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:BROST
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:PO BOX 66
Mailing Address - Street 2:237 W BROADWAY
Mailing Address - City:BLAIR
Mailing Address - State:WI
Mailing Address - Zip Code:54616-0066
Mailing Address - Country:US
Mailing Address - Phone:608-989-2020
Mailing Address - Fax:608-989-2308
Practice Address - Street 1:237 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:WI
Practice Address - Zip Code:54616-9366
Practice Address - Country:US
Practice Address - Phone:608-989-2020
Practice Address - Fax:608-989-2308
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI141964862012OtherBCBS
WI38898000Medicaid
WI38898000Medicaid