Provider Demographics
NPI:1851952063
Name:BRINK, ELIZABETH (ACUPUNCTURE, LAC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BRINK
Suffix:
Gender:F
Credentials:ACUPUNCTURE, LAC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:BRINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:1020 N 12TH ST FL ST4
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-1308
Mailing Address - Country:US
Mailing Address - Phone:414-587-4478
Mailing Address - Fax:
Practice Address - Street 1:1250 MARTHA WASHINGTON DR
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2942
Practice Address - Country:US
Practice Address - Phone:414-587-4478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4829-146225700000X
WI679-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist