Individual
MICHAEL DALE BRACKENRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
363 WOODLAND ST, RICH CREEK, VA 24147-0336
(540) 726-2375
Mailing address
363 WOODLAND ST, PO BOX B, RICH CREEK, VA 24147
(540) 726-2375
(540) 726-3573
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102036943
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005696208
—
VA
Enumeration date
09/22/2006
Last updated
01/28/2011
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