Provider Demographics
NPI:1265475172
Name:BRACKEEN, WENDY (DC)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:BRACKEEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:230 NE 2ND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-3074
Mailing Address - Country:US
Mailing Address - Phone:503-640-2800
Mailing Address - Fax:
Practice Address - Street 1:230 NE 2ND AVE STE 1
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-3074
Practice Address - Country:US
Practice Address - Phone:503-640-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5151111NS0005X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician