Provider Demographics
NPI:1326289976
Name:HANDELAND, BRENT MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:MICHAEL
Last Name:HANDELAND
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 1:1117 GARDEN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FIRECREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466
Mailing Address - Country:US
Mailing Address - Phone:408-544-0060
Mailing Address - Fax:
Practice Address - Street 1:1117 GARDEN CIRCLE
Practice Address - Street 2:
Practice Address - City:FIRECREST
Practice Address - State:WA
Practice Address - Zip Code:98466
Practice Address - Country:US
Practice Address - Phone:408-544-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30973111N00000X
CADC 30973111NX0800X
WACH 60013816111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic