Healthcare Provider Details

I. General information

NPI: 1285201368
Provider Name (Legal Business Name): BRIANNA LOUISE BRANSTETER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANNA LOUISE EDGINTON DC

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19820 VILLAGE OFFICE CT STE 202
BEND OR
97702-2947
US

IV. Provider business mailing address

2681 NE NORTH CIVET CT
BEND OR
97701-6488
US

V. Phone/Fax

Practice location:
  • Phone: 503-801-4230
  • Fax:
Mailing address:
  • Phone: 503-801-4230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number34811
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6397
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: