Provider Demographics
NPI:1508218967
Name:DEVINE, BRANDON R (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:R
Last Name:DEVINE
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 1:2627 N CLAIREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-2405
Mailing Address - Country:US
Mailing Address - Phone:715-552-3232
Mailing Address - Fax:715-552-3233
Practice Address - Street 1:2627 N CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-2405
Practice Address - Country:US
Practice Address - Phone:715-552-3232
Practice Address - Fax:715-552-3233
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5194-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor