Provider Demographics
NPI:1457817132
Name:PERRY-JOHNSON, BRANDI (DC)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:PERRY-JOHNSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 DEER XING
Mailing Address - Street 2:
Mailing Address - City:TODD
Mailing Address - State:NC
Mailing Address - Zip Code:28684-9060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1542 US HWY 421 S STE F
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5301
Practice Address - Country:US
Practice Address - Phone:828-263-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5022111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1457817132Medicaid