Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 6608 | CO |
Y | 111N00000X | Chiropractor | 8273 | AZ |
N | 111NR0400X | Rehabilitation Chiropractor | 4921 | AZ |
N | 225400000X | Rehabilitation Practitioner | 6608 | CO |
NPI | 1427347657 |
---|---|
Provider Name | Dr. Brandon Willmonte Krainik |
First Address | Gilbert, AZ 85295-3452 |
Second Address | Gilbert, AZ 85296-3139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2011 |
Last Update Date | 08/08/2012 |