Provider Demographics
NPI:1851572085
Name:CHASTANT, BRANDON (NMD, FASA)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:CHASTANT
Suffix:
Gender:M
Credentials:NMD, FASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50044
Mailing Address - Street 2:
Mailing Address - City:PARKS
Mailing Address - State:AZ
Mailing Address - Zip Code:86018-0044
Mailing Address - Country:US
Mailing Address - Phone:480-442-4204
Mailing Address - Fax:877-866-0421
Practice Address - Street 1:1623 N MAID MARIAN DR
Practice Address - Street 2:
Practice Address - City:PARKS
Practice Address - State:AZ
Practice Address - Zip Code:86018-0044
Practice Address - Country:US
Practice Address - Phone:480-442-4204
Practice Address - Fax:877-866-0421
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ06-963175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath