Provider Demographics
NPI:1306204110
Name:HARD, BRANDON EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:EDWARD
Last Name:HARD
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 1:6401 DORSETT BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-6017
Mailing Address - Country:US
Mailing Address - Phone:678-838-4433
Mailing Address - Fax:678-838-4093
Practice Address - Street 1:3680 KINGS HWY
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-3336
Practice Address - Country:US
Practice Address - Phone:678-838-4433
Practice Address - Fax:678-838-4093
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor