Provider Demographics
NPI:1689441941
Name:MONDOR, BRANDON THOMAS (DC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:THOMAS
Last Name:MONDOR
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 1:754 190TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:WI
Mailing Address - Zip Code:54025-7405
Mailing Address - Country:US
Mailing Address - Phone:715-808-4553
Mailing Address - Fax:
Practice Address - Street 1:131 CARMICHAEL RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8269
Practice Address - Country:US
Practice Address - Phone:715-386-7690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6144-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor