Healthcare Provider Details

I. General information

NPI: 1780977074
Provider Name (Legal Business Name): BRANDY LYNN VICTORY D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 PLAZA CT N STE 201
LAFAYETTE CO
80026-1467
US

IV. Provider business mailing address

526 HOMESTEAD ST
LAFAYETTE CO
80026-9416
US

V. Phone/Fax

Practice location:
  • Phone: 303-619-7766
  • Fax:
Mailing address:
  • Phone: 303-619-7766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberCHR.0007265
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCHR.0007265
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number30312
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: