Provider Demographics
NPI:1053493544
Name:BRANDON, JENNIFER PAMELA (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:PAMELA
Last Name:BRANDON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-1985
Mailing Address - Country:US
Mailing Address - Phone:239-329-8987
Mailing Address - Fax:
Practice Address - Street 1:618 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-1985
Practice Address - Country:US
Practice Address - Phone:239-329-8987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10987111N00000X
VT720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH 10987OtherFL CHIROPRACTIC LICENSE
FL010227100Medicaid
FLCH 10987OtherFL CHIROPRACTIC LICENSE
FLCH 10987OtherFL CHIROPRACTIC LICENSE
VTT86084Medicare UPIN