Provider Demographics
NPI:1902955602
Name:BRIGHTMAN, ANJENETTE M (DC)
Entity Type:Individual
Prefix:
First Name:ANJENETTE
Middle Name:M
Last Name:BRIGHTMAN
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 1:05539 STATE ROUTE 15
Mailing Address - Street 2:PO BOX 566
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-8874
Mailing Address - Country:US
Mailing Address - Phone:419-636-3133
Mailing Address - Fax:419-636-3188
Practice Address - Street 1:05539 STATE ROUTE 15
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-8874
Practice Address - Country:US
Practice Address - Phone:419-636-3133
Practice Address - Fax:419-636-3188
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2956111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000142171OtherANTHEM BCBS
OH2183702Medicaid
OH350049884OtherRAILROAD MEDICARE
OHBR4014901Medicare ID - Type Unspecified
OHU79581Medicare UPIN