Provider Demographics
NPI:1578319141
Name:BRANNON FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BRANNON FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BRANNON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-227-4891
Mailing Address - Street 1:203 AMICKS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-8663
Mailing Address - Country:US
Mailing Address - Phone:803-932-9399
Mailing Address - Fax:
Practice Address - Street 1:101 GRACE STREET
Practice Address - Street 2:
Practice Address - City:PROSPERITY
Practice Address - State:SC
Practice Address - Zip Code:29127
Practice Address - Country:US
Practice Address - Phone:803-227-4891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRANNON FAMILY CHIROPRACTIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty