Provider Demographics
NPI:1861601486
Name:CREDEUR, BRANDON DAVID (DC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:DAVID
Last Name:CREDEUR
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 1:4155 E JEWELL AVE
Mailing Address - Street 2:STE 1018
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4504
Mailing Address - Country:US
Mailing Address - Phone:303-302-0930
Mailing Address - Fax:303-302-0933
Practice Address - Street 1:4155 E JEWELL AVE
Practice Address - Street 2:STE 1018
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4504
Practice Address - Country:US
Practice Address - Phone:303-302-0930
Practice Address - Fax:303-302-0933
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO540358Medicare PIN
COV00435Medicare UPIN
CO502078Medicare PIN