MEDICARE: DR. BRANDON CHASTANT NMD, FASA

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	175F00000X	Naturopath	06-963	AZ

General Provider Information

NPI Number	:	1851572085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON CHASTANT NMD, FASA

Provider Business Mailing Address
First Line	:	PO BOX 50044
Second Line	:
City	:	PARKS
State	:	AZ
Zip	:	86018-0044
Country	:	US
Telephone Number	:	480-442-4204
Fax Number	:	877-866-0421

Provider Business Practice Location Address
First Line	:	1623 N MAID MARIAN DR
Second Line	:
City	:	PARKS
State	:	AZ
Zip	:	86018-0044
Country	:	US
Telephone Number	:	480-442-4204
Fax Number	:	877-866-0421

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

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	07/15/2014

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