Provider Demographics
NPI:1962589143
Name:CASEY, BRIAN THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:THOMAS
Last Name:CASEY
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 1:68 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10992-1215
Mailing Address - Country:US
Mailing Address - Phone:845-496-5555
Mailing Address - Fax:845-496-5055
Practice Address - Street 1:68 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10992-1215
Practice Address - Country:US
Practice Address - Phone:845-496-5555
Practice Address - Fax:845-496-5055
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX47801Medicare ID - Type UnspecifiedMEDICARE ID
NYU33859Medicare UPIN