Provider Demographics
NPI:1679567036
Name:BRANDON, WILLIAM H JR (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:H
Last Name:BRANDON
Suffix:JR
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 1:191 SAN FELIPE RD
Mailing Address - Street 2:SUITE P
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-3064
Mailing Address - Country:US
Mailing Address - Phone:831-636-1124
Mailing Address - Fax:821-636-8668
Practice Address - Street 1:191 SAN FELIPE RD
Practice Address - Street 2:SUITE P
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-3064
Practice Address - Country:US
Practice Address - Phone:831-636-1124
Practice Address - Fax:821-636-8668
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0158730Medicare ID - Type Unspecified
CAT05940Medicare UPIN