Provider Demographics
NPI:1578995221
Name:RACCA, BRANDON LEE (DC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:LEE
Last Name:RACCA
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 1:1210 E MCNEESE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-4756
Mailing Address - Country:US
Mailing Address - Phone:337-502-5303
Mailing Address - Fax:337-479-2391
Practice Address - Street 1:1210 E MCNEESE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-4756
Practice Address - Country:US
Practice Address - Phone:337-502-5303
Practice Address - Fax:337-479-2391
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor