Individual
BRIAN CHARLES MCGUCKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
412 MARQUETTE ST, VALPARAISO, IN 46383-2563
(219) 531-1234
(219) 531-0476
Mailing address
PO BOX 8907, MICHIGAN CITY, IN 46361-8907
(219) 531-1234
(219) 531-0476
Taxonomy
Speciality
Code
Description
License number
State
111NI0900X
Internist Chiropractor
Primary
08001021A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000019695
ANTHEM PROVIDER
IN
Enumeration date
07/04/2006
Last updated
09/06/2012
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