Provider Demographics
NPI:1093075640
Name:TODD, BRANDON LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:LEE
Last Name:TODD
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 1:1437 HIGUERA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2915
Mailing Address - Country:US
Mailing Address - Phone:805-548-8633
Mailing Address - Fax:
Practice Address - Street 1:1437 HIGUERA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2915
Practice Address - Country:US
Practice Address - Phone:805-548-8633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32256111N00000X
NVB01466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor