Provider Demographics
NPI:1174294839
Name:IMADA, BRANDON (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:IMADA
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 1:12371 S 900 E STE 101
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9834
Mailing Address - Country:US
Mailing Address - Phone:801-544-2355
Mailing Address - Fax:385-529-5922
Practice Address - Street 1:12371 S 900 E STE 101
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9834
Practice Address - Country:US
Practice Address - Phone:801-544-2355
Practice Address - Fax:385-529-5922
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12206047-1202111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician