MEDICARE: DR. BARBARA LYNN BRAKE D.C.

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	0965	SC

General Provider Information

NPI Number	:	1568421444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA LYNN BRAKE D.C.

Provider Business Mailing Address
First Line	:	4010 E NORTH ST
Second Line	:	SUITE ONE
City	:	GREENVILLE
State	:	SC
Zip	:	29615-6207
Country	:	US
Telephone Number	:	864-292-2503
Fax Number	:	864-292-2504

Provider Business Practice Location Address
First Line	:	4010 E NORTH ST
Second Line	:	SUITE ONE
City	:	GREENVILLE
State	:	SC
Zip	:	29615-6207
Country	:	US
Telephone Number	:	864-292-2503
Fax Number	:	864-292-2504

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	07/08/2007

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