Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3381 | CO |
NPI | 1003097726 |
---|---|
Provider Name | Dr. Jerold A Brandt |
First Address | Holyoke, CO 80734-1535 |
Second Address | Holyoke, CO 80734-1535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2007 |
Last Update Date | 21/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C27433 | (02) | CO |