Provider Demographics
NPI:1073405890
Name:AVERY, BRIANNE NOEL (DC)
Entity type:Individual
Prefix:DR
First Name:BRIANNE
Middle Name:NOEL
Last Name:AVERY
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 1:1317 FARM CREST CIR APT 1B
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-8027
Mailing Address - Country:US
Mailing Address - Phone:607-280-4402
Mailing Address - Fax:
Practice Address - Street 1:1317 FARM CREST CIR APT 1B
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-8027
Practice Address - Country:US
Practice Address - Phone:607-280-4402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003414A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor