Provider Demographics
NPI:1952450934
Name:BREKKE, TANJA ANN (LAC (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:TANJA
Middle Name:ANN
Last Name:BREKKE
Suffix:
Gender:F
Credentials:LAC (ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N WILLSON AVE
Mailing Address - Street 2:SUIET 603 F
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3551
Mailing Address - Country:US
Mailing Address - Phone:406-587-1167
Mailing Address - Fax:406-587-1167
Practice Address - Street 1:300 N WILLSON AVE
Practice Address - Street 2:SUIET 603 F
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3551
Practice Address - Country:US
Practice Address - Phone:406-587-1167
Practice Address - Fax:406-587-1167
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT106171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist