Healthcare Provider Details

I. General information

NPI: 1700963972
Provider Name (Legal Business Name): TANSY MADRONE BRIGGS D.O.M., L.OM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 S 15TH ST
PHILADELPHIA PA
19146-2186
US

IV. Provider business mailing address

312 PARSONS AVE
BALA CYNWYD PA
19004-2817
US

V. Phone/Fax

Practice location:
  • Phone: 505-310-8913
  • Fax:
Mailing address:
  • Phone: 505-310-8913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number712
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: