Provider Demographics
NPI:1538321922
Name:BABCOCK, BRANDON LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:LEE
Last Name:BABCOCK
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 1:9265 REDWOOD RD STE A
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5823
Mailing Address - Country:US
Mailing Address - Phone:801-565-1411
Mailing Address - Fax:801-565-1411
Practice Address - Street 1:9265 REDWOOD RD STE A
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5823
Practice Address - Country:US
Practice Address - Phone:801-565-1411
Practice Address - Fax:801-565-1411
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5189485-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000056338Medicare PIN