Provider Demographics
NPI:1639303993
Name:LIVINGOOD, BRANDON REED (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:REED
Last Name:LIVINGOOD
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 1:20551 N PIMA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-9154
Mailing Address - Country:US
Mailing Address - Phone:719-244-5152
Mailing Address - Fax:
Practice Address - Street 1:18025 CALLE AMBIENTE
Practice Address - Street 2:SUITE 204
Practice Address - City:RANCHO SANTA FE
Practice Address - State:CA
Practice Address - Zip Code:92067
Practice Address - Country:US
Practice Address - Phone:858-367-8660
Practice Address - Fax:858-367-8966
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33936111N00000X
CO6324111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33936OtherCALIFORNIA CHIROPRACTIC LICENSE
COCOA103952Medicare PIN