Provider Demographics
NPI:1881934875
Name:GREEN, BRANDT L (DC)
Entity type:Individual
Prefix:
First Name:BRANDT
Middle Name:L
Last Name:GREEN
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 1:45 OLD SOLOMONS ISLAND RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3858
Mailing Address - Country:US
Mailing Address - Phone:410-224-4348
Mailing Address - Fax:410-224-4732
Practice Address - Street 1:45 OLD SOLOMONS ISLAND RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3858
Practice Address - Country:US
Practice Address - Phone:410-224-4348
Practice Address - Fax:410-224-4732
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor