Provider Demographics
NPI:1427422989
Name:BRAZDA, JUSTIN JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:JOSEPH
Last Name:BRAZDA
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 1:10701 S 72ND ST
Mailing Address - Street 2:UNIT 120
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3427
Mailing Address - Country:US
Mailing Address - Phone:402-593-9930
Mailing Address - Fax:
Practice Address - Street 1:10701 S 72ND ST
Practice Address - Street 2:UNIT 120
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3427
Practice Address - Country:US
Practice Address - Phone:402-593-9930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1866111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor