Provider Demographics
NPI:1447371703
Name:BRANSON, CEANN UNDINE (DC)
Entity type:Individual
Prefix:
First Name:CEANN
Middle Name:UNDINE
Last Name:BRANSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 E SAGINAW RD
Mailing Address - Street 2:SUITE #7
Mailing Address - City:SANFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48657-9271
Mailing Address - Country:US
Mailing Address - Phone:989-687-9299
Mailing Address - Fax:989-687-6382
Practice Address - Street 1:152 E SAGINAW RD
Practice Address - Street 2:SUITE #7
Practice Address - City:SANFORD
Practice Address - State:MI
Practice Address - Zip Code:48657-9271
Practice Address - Country:US
Practice Address - Phone:989-687-9299
Practice Address - Fax:989-687-6382
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E65065OtherBCBSM
MI950E65065OtherBCBSM
MIT32608Medicare UPIN