Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 5151 | OR |
NPI | 1265475172 |
---|---|
Provider Name | Dr. Wendy Brackeen |
First Address | Hillsboro, OR 97124-5020 |
Second Address | Hillsboro, OR 97124-5020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 09/02/2018 |