Provider Demographics
NPI:1821038894
Name:WEINREB, BRANDON (LMT LAC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:WEINREB
Suffix:
Gender:M
Credentials:LMT LAC
Other - Prefix:
Other - First Name:RANDY
Other - Middle Name:
Other - Last Name:WEINREB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:21045 BAYOU DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2437
Mailing Address - Country:US
Mailing Address - Phone:541-385-7895
Mailing Address - Fax:
Practice Address - Street 1:21045 BAYOU DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2437
Practice Address - Country:US
Practice Address - Phone:541-385-7895
Practice Address - Fax:541-322-8928
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00170171100000X
OR2427225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist