Provider Demographics
NPI:1720210578
Name:SEIRA GONZALEZ, BREANNA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:BREANNA
Middle Name:MARIE
Last Name:SEIRA GONZALEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14020 HWY 13 S
Mailing Address - Street 2:SUITE 650
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-7100
Mailing Address - Country:US
Mailing Address - Phone:952-447-8980
Mailing Address - Fax:952-447-8941
Practice Address - Street 1:14020 HIGHWAY 13 S
Practice Address - Street 2:SUITE 650
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-7100
Practice Address - Country:US
Practice Address - Phone:952-447-8980
Practice Address - Fax:952-447-8941
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor