Provider Demographics
NPI:1417414715
Name:RACINE, BRETT (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
Last Name:RACINE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-1500
Mailing Address - Country:US
Mailing Address - Phone:802-318-5035
Mailing Address - Fax:
Practice Address - Street 1:170 COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3226
Practice Address - Country:US
Practice Address - Phone:802-318-5035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-23
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3637111N00000X
VT006.0134125111N00000X
NH1037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT006.0134125OtherVERMONT BOARD OF CHIROPRACTIC EXAMINERS
NH1037OtherNEW HAMPSHIRE BOARD OF CHIROPRACTIC EXAMINERS
MA3637OtherMASSACHUSETTS BOARD OF CHIROPRACTORS