Provider Demographics
NPI:1174291231
Name:PINE, BRIAN (LAC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:PINE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1469
Mailing Address - Country:US
Mailing Address - Phone:484-935-3193
Mailing Address - Fax:
Practice Address - Street 1:406 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1469
Practice Address - Country:US
Practice Address - Phone:484-935-3191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001301171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist