Healthcare Provider Details

I. General information

NPI: 1427347657
Provider Name (Legal Business Name): BRANDON WILLMONTE KRAINIK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 S VAL VISTA DR STE 105
GILBERT AZ
85296-3139
US

IV. Provider business mailing address

2132 S MARTINGALE RD
GILBERT AZ
85295-3452
US

V. Phone/Fax

Practice location:
  • Phone: 480-497-2900
  • Fax: 480-497-2906
Mailing address:
  • Phone: 720-878-3664
  • Fax: 480-497-2906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6608
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number6608
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8273
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number4921
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: