Provider Demographics
NPI:1386363414
Name:WALSH, BRANDON (DC)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:WALSH
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 1:70 ALLISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWFOUNDLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07435-1400
Mailing Address - Country:US
Mailing Address - Phone:973-525-0646
Mailing Address - Fax:
Practice Address - Street 1:11 VERNON AVE
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NJ
Practice Address - Zip Code:07419-1108
Practice Address - Country:US
Practice Address - Phone:973-827-8150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00791300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor