Provider Demographics
NPI:1528023769
Name:BYRD, BRANDON DENNIS (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:DENNIS
Last Name:BYRD
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 1:2510 W CHESTNUT AVE STE F
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-3906
Mailing Address - Country:US
Mailing Address - Phone:580-540-3357
Mailing Address - Fax:
Practice Address - Street 1:2510 W CHESTNUT AVE STE F
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-3906
Practice Address - Country:US
Practice Address - Phone:580-540-3357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU86261Medicare UPIN