Provider Demographics
NPI:1508818857
Name:BRANDENBURG, STEPHEN D (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
Last Name:BRANDENBURG
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 1:3189 KIRBY WHITTEN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-2854
Mailing Address - Country:US
Mailing Address - Phone:901-377-3100
Mailing Address - Fax:901-377-4900
Practice Address - Street 1:3189 KIRBY WHITTEN PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2855
Practice Address - Country:US
Practice Address - Phone:901-377-3100
Practice Address - Fax:901-377-4900
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT74493Medicare UPIN
TN26813OtherCHIROPRACTOR
TN3672158Medicare ID - Type UnspecifiedCHIROPRACTOR