Provider Demographics
NPI:1861404600
Name:ROBERTS, BRANDON L (DC)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:L
Last Name:ROBERTS
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 1:215 G STREET
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-1252
Mailing Address - Country:US
Mailing Address - Phone:925-494-0249
Mailing Address - Fax:415-512-1589
Practice Address - Street 1:215 G STREET
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-1252
Practice Address - Country:US
Practice Address - Phone:925-494-0249
Practice Address - Fax:415-512-1589
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 28019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor