Provider Demographics
NPI:1629384805
Name:FLAMM, BRYAN (ACUPUNTURIST DOM)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:FLAMM
Suffix:
Gender:M
Credentials:ACUPUNTURIST DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 CHAMISO LN NW
Mailing Address - Street 2:
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6602
Mailing Address - Country:US
Mailing Address - Phone:505-379-7639
Mailing Address - Fax:
Practice Address - Street 1:524 CHAMISO LN NW
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6602
Practice Address - Country:US
Practice Address - Phone:505-379-7639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM282171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM282OtherDOCTOR OF ORIENTAL MEDICINE