Provider Demographics
NPI:1376828020
Name:MARKOVETZ, BRANDON (DC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:MARKOVETZ
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 1:722 N MAIN ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-2165
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:722 N MAIN ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2165
Practice Address - Country:US
Practice Address - Phone:605-717-0043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1187111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor