Healthcare Provider Details

I. General information

NPI: 1396375606
Provider Name (Legal Business Name): BRANDON RAMAKKO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2020
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CASA DE PARCO APARTMENTS TOWER ORCHIDEA, FLOOR 16, ROOM 2
TANGERANG BANTEN
15345
ID

IV. Provider business mailing address

CASA DE PARCO APARTMENTS TOWER ORCHIDEA, FLOOR 16, ROOM 2
TANGERANG BANTEN
15345
ID

V. Phone/Fax

Practice location:
  • Phone: 971-236-2303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number14337
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number14337
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: