Provider Demographics
NPI:1750513305
Name:BRANCH, JUSTIN H (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:H
Last Name:BRANCH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:537 KENTUCKY AVE
Mailing Address - Street 2:B
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3913
Mailing Address - Country:US
Mailing Address - Phone:985-601-2954
Mailing Address - Fax:985-635-4592
Practice Address - Street 1:537 KENTUCKY AVE
Practice Address - Street 2:B
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3913
Practice Address - Country:US
Practice Address - Phone:985-601-2954
Practice Address - Fax:985-635-4575
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA1523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor