Provider Demographics
NPI:1699139279
Name:SASS, BRIAN (DC, DACNB, FABBIR)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:SASS
Suffix:
Gender:M
Credentials:DC, DACNB, FABBIR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5136 CASCADE RD SE STE 1D
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3728
Mailing Address - Country:US
Mailing Address - Phone:810-310-1206
Mailing Address - Fax:
Practice Address - Street 1:5136 CASCADE RD SE STE 1D
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3728
Practice Address - Country:US
Practice Address - Phone:810-310-1206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11461111NN0400X
GACHIR009527111NN0400X
MECR2339111NN0400X
MI2301011000111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology