Provider Demographics
NPI:1750567079
Name:BRANDON, STEPHEN JAMES (DC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JAMES
Last Name:BRANDON
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 1:54 W TWIN OAKS TER
Mailing Address - Street 2:SUITE 9
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7140
Mailing Address - Country:US
Mailing Address - Phone:802-658-8878
Mailing Address - Fax:802-658-8879
Practice Address - Street 1:2882 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482
Practice Address - Country:US
Practice Address - Phone:802-985-9500
Practice Address - Fax:802-985-4059
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0001208111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1018723Medicaid