Provider Demographics
NPI:1962700815
Name:DECOU, BRETT JAY (DC)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:JAY
Last Name:DECOU
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 1:510 W HEMLOCK ST STE B2
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2553
Mailing Address - Country:US
Mailing Address - Phone:406-219-5323
Mailing Address - Fax:855-506-4350
Practice Address - Street 1:510 W HEMLOCK ST STE B2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2553
Practice Address - Country:US
Practice Address - Phone:406-219-5323
Practice Address - Fax:855-506-4350
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCHI-CHI-LIC-3995111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Yes111N00000XChiropractic ProvidersChiropractor