Provider Demographics
NPI:1720596216
Name:INGERSON, BRANDI NICOLE
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:NICOLE
Last Name:INGERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 N. CUNNINGHAM AVE.
Mailing Address - Street 2:LOCATED IN LEONE
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802
Mailing Address - Country:US
Mailing Address - Phone:217-384-8180
Mailing Address - Fax:
Practice Address - Street 1:909 N CUNNINGHAM AVE
Practice Address - Street 2:LOCATED IN LEONE CHIROPRACTIC
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802
Practice Address - Country:US
Practice Address - Phone:217-384-8180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227014032225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist