Provider Demographics
NPI:1871763300
Name:NATHANSON, BRIAN KENT (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KENT
Last Name:NATHANSON
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 1:3 WENTWORTH DR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1884
Mailing Address - Country:US
Mailing Address - Phone:203-313-3844
Mailing Address - Fax:
Practice Address - Street 1:3 WENTWORTH DR
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1884
Practice Address - Country:US
Practice Address - Phone:203-313-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor