Provider Demographics
NPI:1275631335
Name:ARCHAMBAULT, BRIAN JAMES (NMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JAMES
Last Name:ARCHAMBAULT
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10320 W MCDOWELL RD
Mailing Address - Street 2:M-1342
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-4863
Mailing Address - Country:US
Mailing Address - Phone:623-643-9598
Mailing Address - Fax:623-478-0960
Practice Address - Street 1:10320 W MCDOWELL RD
Practice Address - Street 2:M-1342
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-4863
Practice Address - Country:US
Practice Address - Phone:623-643-9598
Practice Address - Fax:623-478-0960
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03-777175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath