Healthcare Provider Details

I. General information

NPI: 1629384805
Provider Name (Legal Business Name): BRYAN FLAMM ACUPUNTURIST D.O.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 CHAMISO LN NW
LOS RANCHOS NM
87107-6602
US

IV. Provider business mailing address

524 CHAMISO LN NW
LOS RANCHOS NM
87107-6602
US

V. Phone/Fax

Practice location:
  • Phone: 505-379-7639
  • Fax:
Mailing address:
  • Phone: 505-379-7639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number282
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: