Provider Demographics
NPI:1538308028
Name:BIRD, BRANDON R (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:R
Last Name:BIRD
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 1:3908 N 138TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-5009
Mailing Address - Country:US
Mailing Address - Phone:402-932-8131
Mailing Address - Fax:402-493-7909
Practice Address - Street 1:3908 N 138TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-5009
Practice Address - Country:US
Practice Address - Phone:402-932-8131
Practice Address - Fax:402-493-7909
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor