Provider Demographics
NPI:1568421444
Name:BRAKE, BARBARA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:LYNN
Last Name:BRAKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 E NORTH ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6207
Mailing Address - Country:US
Mailing Address - Phone:864-292-2503
Mailing Address - Fax:864-292-2504
Practice Address - Street 1:4010 E NORTH ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6207
Practice Address - Country:US
Practice Address - Phone:864-292-2503
Practice Address - Fax:864-292-2504
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT24972Medicare UPIN