Provider Demographics
NPI:1043643414
Name:BRANDNER, MATTHEW JONATHAN (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JONATHAN
Last Name:BRANDNER
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 1:830 E 41ST ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6028
Mailing Address - Country:US
Mailing Address - Phone:605-338-5511
Mailing Address - Fax:
Practice Address - Street 1:830 E 41ST ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6028
Practice Address - Country:US
Practice Address - Phone:605-338-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5759111N00000X
SD1238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor