Provider Demographics
NPI:1427441146
Name:VON BRINCKEN, FREDERICK (DC)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:VON BRINCKEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85602-6614
Mailing Address - Country:US
Mailing Address - Phone:520-586-9364
Mailing Address - Fax:520-586-1856
Practice Address - Street 1:338 E 4TH ST
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602
Practice Address - Country:US
Practice Address - Phone:520-586-9364
Practice Address - Fax:520-586-1856
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4956111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor