Provider Demographics
NPI:1457749178
Name:GUANZON, BRIAN RAY,OND (MSOM, LAC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:RAY,OND
Last Name:GUANZON
Suffix:
Gender:M
Credentials:MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 SUGAR TREE KNOB RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TN
Mailing Address - Zip Code:37095-9329
Mailing Address - Country:US
Mailing Address - Phone:615-318-6872
Mailing Address - Fax:
Practice Address - Street 1:313 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1144
Practice Address - Country:US
Practice Address - Phone:615-318-6872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN242171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist