Provider Demographics
NPI:1073642567
Name:BRACHT CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:BRACHT CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BRACHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-464-3643
Mailing Address - Street 1:15226 W FREEWAY DR NE
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-9433
Mailing Address - Country:US
Mailing Address - Phone:651-464-3643
Mailing Address - Fax:651-464-2022
Practice Address - Street 1:15226 W FREEWAY DR NE
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-9433
Practice Address - Country:US
Practice Address - Phone:651-464-3643
Practice Address - Fax:651-464-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5C778BROtherBLUE CROSS BLUE SHEILD
MN265726100Medicaid
MN65675Medicare UPIN
MN265726100Medicaid