Provider Demographics
NPI:1558933887
Name:VAN ANNE, BRANDON LEE THOMAS (DC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:LEE THOMAS
Last Name:VAN ANNE
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 1:737 S CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-8412
Mailing Address - Country:US
Mailing Address - Phone:620-794-5466
Mailing Address - Fax:
Practice Address - Street 1:7000 W 121ST ST STE 100
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-2010
Practice Address - Country:US
Practice Address - Phone:620-794-5466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor