Provider Demographics
NPI:1972805778
Name:MANNINEN, BRIANNE RACINE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:BRIANNE
Middle Name:RACINE
Last Name:MANNINEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 LARAMIE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-2006
Mailing Address - Country:US
Mailing Address - Phone:503-803-2017
Mailing Address - Fax:
Practice Address - Street 1:3508 LARAMIE DR STE 3
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-2006
Practice Address - Country:US
Practice Address - Phone:503-803-2017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-ACU-LIC-14656171100000X
WAAC 60122573171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist