Provider Demographics
NPI:1699036897
Name:MCMICHAEL, BRANON SHADD (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:BRANON
Middle Name:SHADD
Last Name:MCMICHAEL
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 S KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5349
Mailing Address - Country:US
Mailing Address - Phone:816-898-9633
Mailing Address - Fax:
Practice Address - Street 1:8335 N CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64152-2041
Practice Address - Country:US
Practice Address - Phone:816-741-4711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012016891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor