Provider Demographics
NPI:1598014177
Name:CHANDLER, BRIAN JEFFERY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JEFFERY
Last Name:CHANDLER
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 1:30079 E MAXTON RD
Mailing Address - Street 2:
Mailing Address - City:DRUMMOND ISLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49726-9538
Mailing Address - Country:US
Mailing Address - Phone:906-322-1815
Mailing Address - Fax:231-922-9621
Practice Address - Street 1:33896 S TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:DRUMMOND ISLAND
Practice Address - State:MI
Practice Address - Zip Code:49726
Practice Address - Country:US
Practice Address - Phone:906-322-1815
Practice Address - Fax:231-922-9621
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009949111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6152Medicaid