Provider Demographics
NPI:1083071302
Name:ANCRUM, BRANDI (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:
Last Name:ANCRUM
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 1:680 E MAIN ST
Mailing Address - Street 2:STE 101
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-4803
Mailing Address - Country:US
Mailing Address - Phone:863-537-7330
Mailing Address - Fax:
Practice Address - Street 1:680 E MAIN ST
Practice Address - Street 2:STE 101
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-4803
Practice Address - Country:US
Practice Address - Phone:863-537-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-16
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor