Provider Demographics
NPI:1154513315
Name:BRAKE, SAM (DC)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:BRAKE
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 1:1570 ABERCORN ST NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-3545
Mailing Address - Country:US
Mailing Address - Phone:704-886-5156
Mailing Address - Fax:
Practice Address - Street 1:19315 W CATAWBA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8650
Practice Address - Country:US
Practice Address - Phone:704-896-1811
Practice Address - Fax:704-896-1812
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3320111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor