MEDICARE: DR. CARRIE ANN ROEDER BRANNOCK 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	DC27850	CA

General Provider Information

NPI Number	:	1992769871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARRIE ANN ROEDER BRANNOCK D.C

Provider Business Mailing Address
First Line	:	2515 CAMINO DEL RIO S STE 110
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3714
Country	:	US
Telephone Number	:	619-291-8111
Fax Number	:	619-291-8118

Provider Business Practice Location Address
First Line	:	2515 CAMINO DEL RIO S STE 110
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3714
Country	:	US
Telephone Number	:	619-291-8111
Fax Number	:	619-291-8118

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	04/27/2020

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