Provider Demographics
NPI:1962756379
Name:HARSHE, BRANDON ROARK (DC)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:ROARK
Last Name:HARSHE
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 1:20800 N JOHN WAYNE PKWY STE 116
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-2728
Mailing Address - Country:US
Mailing Address - Phone:520-350-0074
Mailing Address - Fax:
Practice Address - Street 1:20800 N JOHN WAYNE PKWY STE 116
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-2728
Practice Address - Country:US
Practice Address - Phone:520-350-0074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11348111N00000X
AZ8759111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor