Provider Demographics
NPI:1992769871
Name:ROEDER BRANNOCK, CARRIE ANN (DC)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:ANN
Last Name:ROEDER BRANNOCK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 CAMINO DEL RIO S STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3714
Mailing Address - Country:US
Mailing Address - Phone:619-291-8111
Mailing Address - Fax:619-291-8118
Practice Address - Street 1:2515 CAMINO DEL RIO S STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3714
Practice Address - Country:US
Practice Address - Phone:619-291-8111
Practice Address - Fax:619-291-8118
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor