Provider Demographics
NPI:1740896166
Name:DUNN, BRADEN KEITH (LAC)
Entity type:Individual
Prefix:
First Name:BRADEN
Middle Name:KEITH
Last Name:DUNN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 LAKE PLAZA DR STE 231
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3517
Mailing Address - Country:US
Mailing Address - Phone:719-434-8093
Mailing Address - Fax:
Practice Address - Street 1:1235 LAKE PLAZA DR STE 231
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3517
Practice Address - Country:US
Practice Address - Phone:719-434-8093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002585171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist