Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 38MC00750100 | NJ |
Y | 111NN0400X | Neurology | 38MC00750100 | NJ |
N | 111NN1001X | Nutrition | 38MC00750100 | NJ |
NPI | 1821587577 |
---|---|
Provider Name | Dr. Michael Vincent Brandon |
First Address | Colts Neck, NJ 07722-2427 |
Second Address | Colts Neck, NJ 07722-2427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2018 |
Last Update Date | 18/01/2019 |