Provider Demographics
NPI:1013046168
Name:WENTZEL, BRANDON J (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:J
Last Name:WENTZEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 SILVER LN
Mailing Address - Street 2:STE. 2G
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-1063
Mailing Address - Country:US
Mailing Address - Phone:412-859-3727
Mailing Address - Fax:412-859-3727
Practice Address - Street 1:1229 SILVER LN
Practice Address - Street 2:STE. 2G
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-1063
Practice Address - Country:US
Practice Address - Phone:412-859-3727
Practice Address - Fax:412-859-3727
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA438705OtherHEALTH AMERICA
PA7682678OtherAETNA
PAWE1691029OtherHIGHMARK
PA21403OtherASHN
PA438705OtherHEALTH AMERICA
V05118Medicare UPIN