MEDICARE: DR. BRANDON LAVELLE D.C.

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	9993	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396055737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON LAVELLE D.C.

Provider Business Mailing Address
First Line	:	209 DUNLAWTON AVE STE 18
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4458
Country	:	US
Telephone Number	:	386-308-9076
Fax Number	:	386-675-6591

Provider Business Practice Location Address
First Line	:	209 DUNLAWTON AVE STE 18
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4458
Country	:	US
Telephone Number	:	386-308-9076
Fax Number	:	386-675-6591

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

Provider Enumeration Date	:	10/19/2010
Last Update Date	:	05/12/2026

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