Provider Demographics
NPI:1316082589
Name:ACKERMAN, MICHAEL BRANDON (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRANDON
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:1202 MORENA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3841
Mailing Address - Country:US
Mailing Address - Phone:619-687-7676
Mailing Address - Fax:206-666-2585
Practice Address - Street 1:1110 TORREY PINES RD
Practice Address - Street 2:SUITE G
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4504
Practice Address - Country:US
Practice Address - Phone:619-687-7676
Practice Address - Fax:866-831-4642
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADC18296111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation