Provider Demographics
NPI:1649207432
Name:LANDERS, BRIAN F (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:F
Last Name:LANDERS
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 1:72 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-3965
Mailing Address - Country:US
Mailing Address - Phone:315-370-7988
Mailing Address - Fax:888-345-8190
Practice Address - Street 1:72 SOUTH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3965
Practice Address - Country:US
Practice Address - Phone:315-370-7988
Practice Address - Fax:888-345-8190
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3112111N00000X
NY009689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH3112Medicaid
SCU844110281Medicare UPIN