Provider Demographics
NPI:1336301324
Name:BRASCH, MARTIN JEFFREY (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JEFFREY
Last Name:BRASCH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MARTIN
Other - Middle Name:JEFFREY
Other - Last Name:BRASCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:300 WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-2618
Mailing Address - Country:US
Mailing Address - Phone:419-609-9800
Mailing Address - Fax:
Practice Address - Street 1:300 WAYNE ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-2618
Practice Address - Country:US
Practice Address - Phone:419-609-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2527111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor