Healthcare Provider Details

I. General information

NPI: 1639095672
Provider Name (Legal Business Name): BRANDON LEE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19014 BRUCE B DOWNS BLVD
TAMPA FL
33647-2434
US

IV. Provider business mailing address

17112 CARRINGTON PARK DR APT 906
TAMPA FL
33647-2637
US

V. Phone/Fax

Practice location:
  • Phone: 813-536-4563
  • Fax:
Mailing address:
  • Phone: 727-773-6799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH15565
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: