Provider Demographics
NPI:1104689835
Name:BOON, BRANDON TYLER
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:TYLER
Last Name:BOON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 E MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-2472
Mailing Address - Country:US
Mailing Address - Phone:610-547-2100
Mailing Address - Fax:
Practice Address - Street 1:3605 WINDING WAY
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-4057
Practice Address - Country:US
Practice Address - Phone:610-325-6037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor