Provider Demographics
NPI:1902935497
Name:BRACHT, REBECCA KAY (DC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:KAY
Last Name:BRACHT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 147TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55304-4971
Mailing Address - Country:US
Mailing Address - Phone:763-208-5382
Mailing Address - Fax:763-208-2911
Practice Address - Street 1:1444 147TH AVE NE
Practice Address - Street 2:
Practice Address - City:HAM LAKE
Practice Address - State:MN
Practice Address - Zip Code:55304-4971
Practice Address - Country:US
Practice Address - Phone:763-208-5382
Practice Address - Fax:763-208-2911
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5C779BROtherBLUE CROSS BLUE SHEILD
MN1902935497Medicaid
MN265726100Medicaid
MN350001589Medicare ID - Type UnspecifiedMEDICARE