MEDICARE: DR. JENNIFER PAMELA BRANDON DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH 10987	FL
2	111N00000X	Chiropractor	720	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH 10987	OTHER	FL	FL CHIROPRACTIC LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053493544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER PAMELA BRANDON DC

Provider Business Mailing Address
First Line	:	618 SW 3RD ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-1985
Country	:	US
Telephone Number	:	239-329-8987
Fax Number	:

Provider Business Practice Location Address
First Line	:	618 SW 3RD ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-1985
Country	:	US
Telephone Number	:	239-329-8987
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	04/18/2024

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