Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 550 | CT |
NPI | 1235128968 |
---|---|
Provider Name | Dr. Brian Patrick Batherson |
First Address | Storrs Mansfield, CT 06268-2213 |
Second Address | Storrs, CT 06268-2213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2005 |
Last Update Date | 16/03/2015 |