Provider Demographics
NPI:1912322520
Name:KULP, BRANDON GEOFFREY (DC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:GEOFFREY
Last Name:KULP
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 1:20283 N LAKE PLEASANT RD
Mailing Address - Street 2:STE 112
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-9701
Mailing Address - Country:US
Mailing Address - Phone:623-376-8225
Mailing Address - Fax:623-376-8227
Practice Address - Street 1:20283 N LAKE PLEASANT RD
Practice Address - Street 2:STE 112
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-9701
Practice Address - Country:US
Practice Address - Phone:623-376-8225
Practice Address - Fax:623-376-8227
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8372111NR0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation