Provider Demographics
NPI:1801120324
Name:SCHULTZ, BRANDON (DC)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:SCHULTZ
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 1:5601 NE ANTIOCH RD
Mailing Address - Street 2:STE 8
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64119-2375
Mailing Address - Country:US
Mailing Address - Phone:816-830-3759
Mailing Address - Fax:
Practice Address - Street 1:2943 NE WALNUT RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:MO
Practice Address - Zip Code:64117-2447
Practice Address - Country:US
Practice Address - Phone:816-830-3759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009011867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor