Provider Demographics
NPI:1366565657
Name:MCALISTER, BRANDON KENNETH (DC)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:KENNETH
Last Name:MCALISTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218B MCEVER RD
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-2237
Mailing Address - Country:US
Mailing Address - Phone:770-503-1700
Mailing Address - Fax:770-503-1781
Practice Address - Street 1:4218B MCEVER RD
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2237
Practice Address - Country:US
Practice Address - Phone:770-503-1700
Practice Address - Fax:770-503-1781
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009633111N00000X
SCSC#3242111N00000X
FLCH10182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH3242Medicaid
SCAA22670281Medicare UPIN