Provider Demographics
NPI:1861578734
Name:MANSON, BRANDON L (DC)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:L
Last Name:MANSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:351 FAIRVIEW AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-1259
Mailing Address - Country:US
Mailing Address - Phone:518-828-3662
Mailing Address - Fax:518-828-3845
Practice Address - Street 1:351 FAIRVIEW AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1258
Practice Address - Country:US
Practice Address - Phone:518-828-3662
Practice Address - Fax:518-828-3845
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYX010809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20-0679361OtherBX/BS # TAX ID
NYNY10809OtherLANDMARK HEALTH CARE
NYNY10809OtherLANDMARK HEALTH CARE