Provider Demographics
NPI:1811905037
Name:SHAFER, BRANDI LEIGH (DC)
Entity type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:LEIGH
Last Name:SHAFER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 W HENDERSON ST STE A
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4108
Mailing Address - Country:US
Mailing Address - Phone:817-641-4042
Mailing Address - Fax:817-645-4357
Practice Address - Street 1:1649 W HENDERSON ST STE A
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4108
Practice Address - Country:US
Practice Address - Phone:817-641-4042
Practice Address - Fax:817-645-4357
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8380DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A7232OtherBCBS OF TX PROVIDER ID
TX5669690OtherFIRST HEALTH PROV. ID
TX7287563OtherAETNA PROVIDER ID