Provider Demographics
NPI:1275527384
Name:HOLMES, BRANDON M (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:M
Last Name:HOLMES
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 1:1280 CIVIC DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-7233
Mailing Address - Country:US
Mailing Address - Phone:925-938-1122
Mailing Address - Fax:925-464-7826
Practice Address - Street 1:1280 CIVIC DR
Practice Address - Street 2:SUITE 104
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-7233
Practice Address - Country:US
Practice Address - Phone:925-938-1122
Practice Address - Fax:925-464-7826
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2013-11-01
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
CADC-29529111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0295290Medicare ID - Type Unspecified
CAV02907Medicare UPIN