Provider Demographics
NPI:1447604897
Name:JANIKE, BRANDON
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:JANIKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26322 15TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNESOTA LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56068-2302
Mailing Address - Country:US
Mailing Address - Phone:507-995-7653
Mailing Address - Fax:
Practice Address - Street 1:26322 15TH ST
Practice Address - Street 2:
Practice Address - City:MINNESOTA LAKE
Practice Address - State:MN
Practice Address - Zip Code:56068-2302
Practice Address - Country:US
Practice Address - Phone:507-995-7653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer