Provider Demographics
NPI:1518280890
Name:COUCHMAN, BRANDON LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:LEE
Last Name:COUCHMAN
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 1:10451 W GARVERDALE CT STE 204
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5475
Mailing Address - Country:US
Mailing Address - Phone:208-287-9393
Mailing Address - Fax:208-287-9394
Practice Address - Street 1:10451 W GARVERDALE CT STE 204
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5475
Practice Address - Country:US
Practice Address - Phone:208-287-9393
Practice Address - Fax:208-287-9394
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor