Provider Demographics
NPI:1871523431
Name:FOLLETT-BRUBAKER, LACY RAE (DC)
Entity type:Individual
Prefix:DR
First Name:LACY
Middle Name:RAE
Last Name:FOLLETT-BRUBAKER
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 1:105 E VEST ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:IA
Mailing Address - Zip Code:50129-2752
Mailing Address - Country:US
Mailing Address - Phone:515-386-4753
Mailing Address - Fax:
Practice Address - Street 1:105 E VEST ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:IA
Practice Address - Zip Code:50129-2752
Practice Address - Country:US
Practice Address - Phone:515-386-4753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA30900OtherBLUE CROSS BLUE SHIELD
IA0285429Medicaid
IA0285429Medicaid