Provider Demographics
NPI:1396999322
Name:BRICCA, MARK (ND, MAC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:BRICCA
Suffix:
Gender:M
Credentials:ND, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 SW HILLWOOD CT UNIT 2
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2572
Mailing Address - Country:US
Mailing Address - Phone:541-201-2461
Mailing Address - Fax:866-748-7842
Practice Address - Street 1:2900 NW CLEARWATER DR
Practice Address - Street 2:STE. 200
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703
Practice Address - Country:US
Practice Address - Phone:541-201-2461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01292171100000X
CAND820175F00000X
OR1652175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist