Provider Demographics
NPI:1588035836
Name:BECKERMAN, BRANDON (DC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:BECKERMAN
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 1:9340 RIGGS ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-1441
Mailing Address - Country:US
Mailing Address - Phone:620-921-0979
Mailing Address - Fax:
Practice Address - Street 1:5600 W 95TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-2921
Practice Address - Country:US
Practice Address - Phone:620-921-0979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor