Provider Demographics
NPI:1205187358
Name:BRACHMAN, JARRYL IVE (DC)
Entity Type:Individual
Prefix:DR
First Name:JARRYL
Middle Name:IVE
Last Name:BRACHMAN
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 1:1414 S MILLER ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6923
Mailing Address - Country:US
Mailing Address - Phone:805-922-8361
Mailing Address - Fax:
Practice Address - Street 1:1414 S MILLER ST
Practice Address - Street 2:SUITE 5
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6923
Practice Address - Country:US
Practice Address - Phone:805-922-8361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor