Provider Demographics
NPI:1720838345
Name:CHISM, BRANDON MICHAEL
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:MICHAEL
Last Name:CHISM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 CHIEFTON WAY
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26591-9246
Mailing Address - Country:US
Mailing Address - Phone:304-657-4170
Mailing Address - Fax:
Practice Address - Street 1:231 CHIEFTON WAY
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:WV
Practice Address - Zip Code:26591-9246
Practice Address - Country:US
Practice Address - Phone:304-657-4170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant