Provider Demographics
NPI:1336390152
Name:BRAASCH, BRYSON (RPH,L ACU)
Entity Type:Individual
Prefix:
First Name:BRYSON
Middle Name:
Last Name:BRAASCH
Suffix:
Gender:M
Credentials:RPH,L ACU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6821 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-5570
Mailing Address - Country:US
Mailing Address - Phone:260-402-7643
Mailing Address - Fax:
Practice Address - Street 1:6821 WOODCREST DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-5570
Practice Address - Country:US
Practice Address - Phone:260-402-7643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000104A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist