Provider Demographics
NPI:1356813588
Name:LAMBACH, BREANNA RAE (DC)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:RAE
Last Name:LAMBACH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:RAE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3140 HARBOR LN N STE 102
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5118
Mailing Address - Country:US
Mailing Address - Phone:763-230-7333
Mailing Address - Fax:
Practice Address - Street 1:3140 HARBOR LN N STE 102
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5118
Practice Address - Country:US
Practice Address - Phone:763-230-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6561OtherCHIROPRACTIC BOARD