Provider Demographics
NPI:1669926705
Name:GOEDECKE-SHILLING, BRANDEE (DACM)
Entity type:Individual
Prefix:DR
First Name:BRANDEE
Middle Name:
Last Name:GOEDECKE-SHILLING
Suffix:
Gender:F
Credentials:DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 E 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-5220
Mailing Address - Country:US
Mailing Address - Phone:720-515-1405
Mailing Address - Fax:
Practice Address - Street 1:1355 E 22ND AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5220
Practice Address - Country:US
Practice Address - Phone:720-515-1405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1842171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist