Healthcare Provider Details

I. General information

NPI: 1023608791
Provider Name (Legal Business Name): VICTORIA BRENNECKE ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SHAKER RD STE B222
SHIRLEY MA
01464-2568
US

IV. Provider business mailing address

2 SHAKER RD STE B222
SHIRLEY MA
01464-2568
US

V. Phone/Fax

Practice location:
  • Phone: 978-571-9772
  • Fax:
Mailing address:
  • Phone: 978-571-9772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MRS. VICTORIA BRENNECKE
Title or Position: ACUPUNCTURIST
Credential: DAC
Phone: 978-790-4901