MEDICARE: BRANDON JANUARY 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	3996	OK

General Provider Information

NPI Number	:	1538477120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON JANUARY DC

Provider Business Mailing Address
First Line	:	15007 BRISTOL PARK BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73013
Country	:	US
Telephone Number	:	405-749-8000
Fax Number	:	405-749-8007

Provider Business Practice Location Address
First Line	:	15007 BRISTOL PARK BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73013
Country	:	US
Telephone Number	:	405-749-8000
Fax Number	:	405-749-8007

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

Provider Enumeration Date	:	09/17/2010
Last Update Date	:	09/17/2010

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Directions to “ BRANDON JANUARY DC” Practice Location

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