Provider Demographics
NPI:1932686722
Name:DENIKE, BRANDON DISBROW (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:DISBROW
Last Name:DENIKE
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 1:212 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-3130
Mailing Address - Country:US
Mailing Address - Phone:479-524-5103
Mailing Address - Fax:479-524-9638
Practice Address - Street 1:212 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3130
Practice Address - Country:US
Practice Address - Phone:479-524-5103
Practice Address - Fax:479-524-9638
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor