Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 30973 | CA |
Y | 111N00000X | Chiropractor | CH 60013816 | WA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | DC 30973 | CA |
NPI | 1326289976 |
---|---|
Provider Name | Dr. Brent Michael Handeland |
First Address | Firecrest, WA 98466 |
Second Address | Firecrest, WA 98466 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2009 |
Last Update Date | 08/10/2019 |