Provider Demographics
NPI:1730628561
Name:BRAZINSKI, ALEX (LAC)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:BRAZINSKI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15853-1231
Mailing Address - Country:US
Mailing Address - Phone:814-594-6756
Mailing Address - Fax:
Practice Address - Street 1:324 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:PA
Practice Address - Zip Code:15853
Practice Address - Country:US
Practice Address - Phone:814-594-6756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001198171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist