Provider Demographics
NPI:1033870753
Name:OZBALIK, BRANDON EMILIO (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:EMILIO
Last Name:OZBALIK
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 1:3840 PARK AVE STE D108
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2563
Mailing Address - Country:US
Mailing Address - Phone:732-902-2302
Mailing Address - Fax:732-902-2302
Practice Address - Street 1:3840 PARK AVE STE D108
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2563
Practice Address - Country:US
Practice Address - Phone:732-902-2302
Practice Address - Fax:732-902-2305
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00787900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty