Provider Demographics
NPI:1598193302
Name:DR. JENNIFER BRANDON LLC
Entity Type:Organization
Organization Name:DR. JENNIFER BRANDON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-800-5197
Mailing Address - Street 1:3316 CHIQUITA BLVD S STE 1
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-5111
Mailing Address - Country:US
Mailing Address - Phone:239-800-5197
Mailing Address - Fax:
Practice Address - Street 1:3316 CHIQUITA BLVD S STE 1
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-5111
Practice Address - Country:US
Practice Address - Phone:239-800-5197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty