Provider Demographics
NPI:1700256906
Name:BRANDT, THADEUS J (DC)
Entity Type:Individual
Prefix:
First Name:THADEUS
Middle Name:J
Last Name:BRANDT
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:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:CALLICOON
Mailing Address - State:NY
Mailing Address - Zip Code:12723-0492
Mailing Address - Country:US
Mailing Address - Phone:845-428-4885
Mailing Address - Fax:585-625-0569
Practice Address - Street 1:20 GREGORY ST
Practice Address - Street 2:
Practice Address - City:CALLICOON
Practice Address - State:NY
Practice Address - Zip Code:12723-5322
Practice Address - Country:US
Practice Address - Phone:845-428-4885
Practice Address - Fax:585-625-0569
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011077111N00000X
PAAJ010847111NR0400X
NY013375111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation