Provider Demographics
NPI:1689066813
Name:BRIGGS, KYLE BENJAMIN (LAC)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:BENJAMIN
Last Name:BRIGGS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12819 NORTHWOODS BLVD
Mailing Address - Street 2:UNIT 2
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-5325
Mailing Address - Country:US
Mailing Address - Phone:916-759-8967
Mailing Address - Fax:
Practice Address - Street 1:10775 PIONEER TRL
Practice Address - Street 2:108
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0232
Practice Address - Country:US
Practice Address - Phone:530-563-6403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16238171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist