Provider Demographics
NPI:1053739060
Name:CLEASBY, BREANNA (DC)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:CLEASBY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 M 89
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-8216
Mailing Address - Country:US
Mailing Address - Phone:269-339-0889
Mailing Address - Fax:
Practice Address - Street 1:9801 M 89
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MI
Practice Address - Zip Code:49083
Practice Address - Country:US
Practice Address - Phone:269-339-0889
Practice Address - Fax:269-629-0456
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010153111N00000X, 111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner