Provider Demographics
NPI:1467784892
Name:FIEDLER, BRANDON ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:ROBERT
Last Name:FIEDLER
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 1:55 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:PA
Mailing Address - Zip Code:17847-1728
Mailing Address - Country:US
Mailing Address - Phone:570-742-8495
Mailing Address - Fax:570-713-1953
Practice Address - Street 1:55 CENTER ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:PA
Practice Address - Zip Code:17847-1728
Practice Address - Country:US
Practice Address - Phone:570-742-8495
Practice Address - Fax:570-713-1953
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor