MEDICARE: BRYAN D FREIBERG LAC

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	171100000X	Acupuncturist	LAC-010086	AZ

General Provider Information

NPI Number	:	1235701095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN D FREIBERG LAC

Provider Business Mailing Address
First Line	:	2520 SAN JUAN DR
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-3142
Country	:	US
Telephone Number	:	808-754-5335
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520 SAN JUAN DR
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-3142
Country	:	US
Telephone Number	:	808-754-5335
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2021
Last Update Date	:	07/12/2021

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Directions to “ BRYAN D FREIBERG LAC” Practice Location

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