Provider Demographics
NPI:1740586346
Name:BACON, BRONWYN ELIZABETH (ND)
Entity Type:Individual
Prefix:DR
First Name:BRONWYN
Middle Name:ELIZABETH
Last Name:BACON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W MAIN ST
Mailing Address - Street 2:1C
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3336
Mailing Address - Country:US
Mailing Address - Phone:406-219-3631
Mailing Address - Fax:406-760-1809
Practice Address - Street 1:801 W MAIN ST
Practice Address - Street 2:1C
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3336
Practice Address - Country:US
Practice Address - Phone:406-219-3631
Practice Address - Fax:406-760-1809
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT 60200616175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath