Provider Demographics
NPI:1629135819
Name:BRANDON MANNIE D.C. LLC
Entity Type:Organization
Organization Name:BRANDON MANNIE D.C. LLC
Other - Org Name:DBA CLIFF ROAD CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MANNIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-452-2225
Mailing Address - Street 1:4555 ERIN DRIVE
Mailing Address - Street 2:210
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122
Mailing Address - Country:US
Mailing Address - Phone:651-452-2225
Mailing Address - Fax:651-686-6871
Practice Address - Street 1:4555 ERIN DR
Practice Address - Street 2:210
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3398
Practice Address - Country:US
Practice Address - Phone:651-452-2225
Practice Address - Fax:651-686-6871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty