Provider Demographics
NPI:1164799383
Name:VENDEN, BRANDON A (DC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:A
Last Name:VENDEN
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 1:1611 JIMMIE DAVIS HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-4556
Mailing Address - Country:US
Mailing Address - Phone:318-752-1201
Mailing Address - Fax:318-752-1203
Practice Address - Street 1:1611 JIMMIE DAVIS HWY
Practice Address - Street 2:SUITE C
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-4556
Practice Address - Country:US
Practice Address - Phone:318-752-1201
Practice Address - Fax:318-752-1203
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1625111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition