Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 5156 | CO |
NPI | 1003970484 |
---|---|
Provider Name | Dr. Tina Bragg |
First Address | Colorado Springs, CO 80918-1465 |
Second Address | Colorado Springs, CO 80918-1465 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 25/07/2008 |