Provider Demographics
NPI:1588143044
Name:COTNER, BRANDON WILLIAM (DC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:WILLIAM
Last Name:COTNER
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 1:2271 US HIGHWAY 220
Mailing Address - Street 2:
Mailing Address - City:MUNCY
Mailing Address - State:PA
Mailing Address - Zip Code:17756-6325
Mailing Address - Country:US
Mailing Address - Phone:570-447-2534
Mailing Address - Fax:
Practice Address - Street 1:2271 US HIGHWAY 220
Practice Address - Street 2:
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-6325
Practice Address - Country:US
Practice Address - Phone:570-447-2534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor