Provider Demographics
NPI:1962407403
Name:KULBIEDA, BRIAN J (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:KULBIEDA
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 1:1300 W RIDGE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3194
Mailing Address - Country:US
Mailing Address - Phone:906-226-3663
Mailing Address - Fax:906-226-2956
Practice Address - Street 1:1300 W RIDGE ST STE 1
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3194
Practice Address - Country:US
Practice Address - Phone:906-226-3663
Practice Address - Fax:906-226-2956
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBK008347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU85640Medicare UPIN
MIP31050001Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
MIP00119814Medicare ID - Type UnspecifiedRAILROAD MEDICARE #