Provider Demographics
NPI:1730272899
Name:BRANDT, JAMES R (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:BRANDT
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 1:330 NORTHDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-3362
Mailing Address - Country:US
Mailing Address - Phone:763-755-4300
Mailing Address - Fax:763-755-4375
Practice Address - Street 1:330 NORTHDALE BLVD
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-3362
Practice Address - Country:US
Practice Address - Phone:763-755-4300
Practice Address - Fax:763-755-4375
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1196111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN043N0BROtherBLUECROSS BLUESHIELD
MNP00375338OtherRAILROAD MEDICARE
MN043N0BROtherBLUECROSS BLUESHIELD