Provider Demographics
NPI:1518218239
Name:EISENBEISS BROACH, JULIA (MAC, LAC, DIPLAC)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:
Last Name:EISENBEISS BROACH
Suffix:
Gender:F
Credentials:MAC, LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-1539
Mailing Address - Country:US
Mailing Address - Phone:757-622-7145
Mailing Address - Fax:757-622-7146
Practice Address - Street 1:819 W 21ST ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1539
Practice Address - Country:US
Practice Address - Phone:757-622-7145
Practice Address - Fax:757-622-7146
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000233171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist