Provider Demographics
NPI:1477864742
Name:BRUGGER, CARRIE LYNN (LAC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN
Last Name:BRUGGER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 S PEARL ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3170
Mailing Address - Country:US
Mailing Address - Phone:303-916-2745
Mailing Address - Fax:
Practice Address - Street 1:7230 S PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-1154
Practice Address - Country:US
Practice Address - Phone:303-916-2745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1241171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist