Provider Demographics
NPI:1922501386
Name:MAZE, BRANDON JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:JAMES
Last Name:MAZE
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 1:51 CHESTNUT ST E
Mailing Address - Street 2:STE 1A
Mailing Address - City:NASHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47448-7607
Mailing Address - Country:US
Mailing Address - Phone:812-994-8051
Mailing Address - Fax:
Practice Address - Street 1:51 CHESTNUT ST E
Practice Address - Street 2:STE 1A
Practice Address - City:NASHVILLE
Practice Address - State:IN
Practice Address - Zip Code:47448-7607
Practice Address - Country:US
Practice Address - Phone:812-994-8051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003021A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor