Provider Demographics
NPI:1376690750
Name:BIRD, BRANDON WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:WILLIAM
Last Name:BIRD
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 1:1307 WHITE HORSE RD
Mailing Address - Street 2:BUILDING B STE 200
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2119
Mailing Address - Country:US
Mailing Address - Phone:856-783-6789
Mailing Address - Fax:856-783-7199
Practice Address - Street 1:1307 WHITE HORSE RD
Practice Address - Street 2:BUILDING B SUITE 200
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2119
Practice Address - Country:US
Practice Address - Phone:856-783-6789
Practice Address - Fax:856-783-7199
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00606300111N00000X
PADC009084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ113676280OtherHORIZON BCBS
PA113676280OtherCARPENTERS HEALTH AND WEL
NJ113676280OtherALLSTATE
PA2212354000OtherAMERIHEALTH PPO
GA665240OtherACN
NJ0062766Medicaid
NJ113676280OtherATLANTICARE ADMINISTRATOR
NJ113676280OtherCONCENTRA
UT113676280OtherDESERET MUTUAL
MD066247OtherAPWU HEALTH PLAN
TX3020655OtherAETNA
GA665240OtherUNITED HEALTH CARE
PA2212354000OtherKEYSTONE HEALTH PLAN EAST
PA2213023000OtherINDEPENDENCE BLUE CROSS
NJ3020655OtherAETNA HMO
NJU93507Medicare UPIN
NJ113676280OtherHORIZON BCBS