Provider Demographics
NPI:1811005085
Name:MANNIE, BRANDON (DC)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:MANNIE
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 1:14698 GALAXIE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-8574
Mailing Address - Country:US
Mailing Address - Phone:952-891-2225
Mailing Address - Fax:952-891-4468
Practice Address - Street 1:14698 GALAXIE AVE
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-8574
Practice Address - Country:US
Practice Address - Phone:952-891-2225
Practice Address - Fax:952-891-4468
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor