Provider Demographics
NPI:1992884951
Name:PASA, BRANDON KYLE (DC)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:KYLE
Last Name:PASA
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 1:16500 SE 15TH ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9665
Mailing Address - Country:US
Mailing Address - Phone:360-882-8222
Mailing Address - Fax:360-882-8773
Practice Address - Street 1:16500 SE 15TH ST
Practice Address - Street 2:SUITE 160
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9665
Practice Address - Country:US
Practice Address - Phone:360-882-8222
Practice Address - Fax:360-882-8773
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH34338111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8801188Medicare ID - Type Unspecified