Provider Demographics
NPI:1912683558
Name:TAX, RACHAEL LYNN BREINLING (LAC)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:LYNN BREINLING
Last Name:TAX
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 1:4655 14 MILE RD NE STE B
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-7308
Mailing Address - Country:US
Mailing Address - Phone:616-884-0645
Mailing Address - Fax:
Practice Address - Street 1:4655 14 MILE RD NE STE B
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-7308
Practice Address - Country:US
Practice Address - Phone:616-884-0645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
MI5402000196171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No133N00000XDietary & Nutritional Service ProvidersNutritionist