Provider Demographics
NPI:1902082696
Name:BRAHMER, SCOTT GRANGER (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:GRANGER
Last Name:BRAHMER
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 1:8501 E MILL PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-2010
Mailing Address - Country:US
Mailing Address - Phone:360-718-2346
Mailing Address - Fax:360-718-2347
Practice Address - Street 1:8501 E MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2010
Practice Address - Country:US
Practice Address - Phone:360-718-2346
Practice Address - Fax:360-718-2347
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-13
Last Update Date:2008-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034864111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor