Provider Demographics
NPI:1588087845
Name:BRAMMEIER, BRANDON (DC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:BRAMMEIER
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 1:11503 STATE ROUTE
Mailing Address - Street 2:
Mailing Address - City:OKAWVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62271
Mailing Address - Country:US
Mailing Address - Phone:618-218-6211
Mailing Address - Fax:
Practice Address - Street 1:11503 STATE ROUTE 177
Practice Address - Street 2:
Practice Address - City:OKAWVILLE
Practice Address - State:IL
Practice Address - Zip Code:62271-3647
Practice Address - Country:US
Practice Address - Phone:618-218-6211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012576111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor