Provider Demographics
NPI:1770227357
Name:BRAKACHE, MARIEM (DC)
Entity Type:Individual
Prefix:DR
First Name:MARIEM
Middle Name:
Last Name:BRAKACHE
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 1:3006 SPRING HILL PKWY SE APT A
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4707
Mailing Address - Country:US
Mailing Address - Phone:678-701-5134
Mailing Address - Fax:
Practice Address - Street 1:3180 N POINT PKWY STE 101
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4349
Practice Address - Country:US
Practice Address - Phone:678-701-5134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO10473111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor