Provider Demographics
NPI:1275878308
Name:BOOTHE, BRANDON LEE (DC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:LEE
Last Name:BOOTHE
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 1:7645 E EVANS RD STE 140
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3492
Mailing Address - Country:US
Mailing Address - Phone:408-598-6219
Mailing Address - Fax:
Practice Address - Street 1:7645 E EVANS RD STE 140
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3492
Practice Address - Country:US
Practice Address - Phone:408-598-6219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32126111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician