Provider Demographics
NPI:1689990814
Name:MAHL, BRANDON CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:CHRISTOPHER
Last Name:MAHL
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 1:4729 DAVID DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3332
Mailing Address - Country:US
Mailing Address - Phone:504-296-3733
Mailing Address - Fax:
Practice Address - Street 1:4729 DAVID DR
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3332
Practice Address - Country:US
Practice Address - Phone:504-296-3733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor