1548250517 NPI number — DR. BENJAMIN ZACHARY BRISJAR D.C

Table of content: DR. BENJAMIN ZACHARY BRISJAR D.C (NPI 1548250517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548250517 NPI number — DR. BENJAMIN ZACHARY BRISJAR D.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRISJAR
Provider First Name:
BENJAMIN
Provider Middle Name:
ZACHARY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VALDEZ
Provider Other First Name:
NORA
Provider Other Middle Name:
FANGON
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548250517
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8863
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURG
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94565-8863
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-237-4444
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3105 RAILROAD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURG
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94565-5252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-237-4444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC-27428 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: DC-906 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 006.0073726 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DC-906 . This is a "CHIROPRACTIC LICENSE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 006.0073726 . This is a "CHIROPRACTIC LICENSE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".