Provider Demographics
NPI:1083031843
Name:BRECKE, MITCHELL ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:ALAN
Last Name:BRECKE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5480 NATHAN LANE NORTH
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-1868
Mailing Address - Country:US
Mailing Address - Phone:763-316-5252
Mailing Address - Fax:763-316-5253
Practice Address - Street 1:5480 NATHAN LANE NORTH
Practice Address - Street 2:SUITE 102
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-1868
Practice Address - Country:US
Practice Address - Phone:763-316-5252
Practice Address - Fax:763-316-5253
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5854111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor