Provider Demographics
NPI:1962299396
Name:CROWDIS, BRANDON
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:CROWDIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 BLUE COVE DR APT 213
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-2682
Mailing Address - Country:US
Mailing Address - Phone:678-877-5134
Mailing Address - Fax:
Practice Address - Street 1:221 E 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7612
Practice Address - Country:US
Practice Address - Phone:850-215-1747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15447111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor