Healthcare Provider Details

I. General information

NPI: 1932704152
Provider Name (Legal Business Name): EMELIA CAROL ANN BRACKEN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 30TH ST NE
CANTON OH
44714-1404
US

IV. Provider business mailing address

807 30TH ST NE
CANTON OH
44714-1404
US

V. Phone/Fax

Practice location:
  • Phone: 330-491-0381
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-05016
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: