Provider Demographics
NPI:1932419728
Name:CRUZ, BRANDANT ISAAC (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDANT
Middle Name:ISAAC
Last Name:CRUZ
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 1:4775 LEXINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2801
Mailing Address - Country:US
Mailing Address - Phone:512-775-9655
Mailing Address - Fax:281-499-2936
Practice Address - Street 1:4775 LEXINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2801
Practice Address - Country:US
Practice Address - Phone:512-775-9655
Practice Address - Fax:281-499-2936
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor