Provider Demographics
NPI:1548250517
Name:BRISJAR, BENJAMIN ZACHARY (DC)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ZACHARY
Last Name:BRISJAR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:NORA
Other - Middle Name:FANGON
Other - Last Name:VALDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 8863
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-8863
Mailing Address - Country:US
Mailing Address - Phone:925-237-4444
Mailing Address - Fax:
Practice Address - Street 1:3105 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5252
Practice Address - Country:US
Practice Address - Phone:925-237-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-27428111N00000X
HIDC-906111N00000X
VT006.0073726111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIDC-906OtherCHIROPRACTIC LICENSE
VT006.0073726OtherCHIROPRACTIC LICENSE
CADC0274280Medicare ID - Type UnspecifiedMEDICARE