Provider Demographics
NPI:1427238963
Name:BRAZZALE, CARRIE L (DC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:BRAZZALE
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 1:601 BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-6817
Mailing Address - Country:US
Mailing Address - Phone:920-684-8765
Mailing Address - Fax:920-684-2094
Practice Address - Street 1:601 BUFFALO ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-6817
Practice Address - Country:US
Practice Address - Phone:920-684-8765
Practice Address - Fax:920-684-2094
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4347012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor