MEDICARE: BRANDON DAVID CREDEUR D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5389	CO

General Provider Information

NPI Number	:	1861601486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON DAVID CREDEUR D.C.

Provider Business Mailing Address
First Line	:	4155 E JEWELL AVE
Second Line	:	STE 1018
City	:	DENVER
State	:	CO
Zip	:	80222-4504
Country	:	US
Telephone Number	:	303-302-0930
Fax Number	:	303-302-0933

Provider Business Practice Location Address
First Line	:	4155 E JEWELL AVE
Second Line	:	STE 1018
City	:	DENVER
State	:	CO
Zip	:	80222-4504
Country	:	US
Telephone Number	:	303-302-0930
Fax Number	:	303-302-0933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/09/2007

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