MEDICARE: BRACHT CHIROPRACTIC, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3365	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5C778BR	OTHER	MN	BLUE CROSS BLUE SHEILD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073642567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRACHT CHIROPRACTIC, P.A.

Provider Business Mailing Address
First Line	:	15226 W FREEWAY DR NE
Second Line	:
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-9433
Country	:	US
Telephone Number	:	651-464-3643
Fax Number	:	651-464-2022

Provider Business Practice Location Address
First Line	:	15226 W FREEWAY DR NE
Second Line	:
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-9433
Country	:	US
Telephone Number	:	651-464-3643
Fax Number	:	651-464-2022

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. REBECCA KAY BRACHT
Credential	:	DC
Telephone Number	:	651-464-3643

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	09/20/2010

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