Provider Demographics
NPI:1093023871
Name:PAUL BRANDT, D.C.
Entity Type:Organization
Organization Name:PAUL BRANDT, D.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-522-3713
Mailing Address - Street 1:4352 COCHRAN ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2352
Mailing Address - Country:US
Mailing Address - Phone:805-522-3713
Mailing Address - Fax:805-522-9940
Practice Address - Street 1:4352 COCHRAN ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2352
Practice Address - Country:US
Practice Address - Phone:805-522-3713
Practice Address - Fax:805-522-9940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13948261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC13948Medicare PIN