Provider Demographics
NPI:1447474242
Name:BRANDVOLD & ASSOCIATES LLC
Entity type:Organization
Organization Name:BRANDVOLD & ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDVOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-563-6761
Mailing Address - Street 1:2401 E 42ND AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5205
Mailing Address - Country:US
Mailing Address - Phone:907-563-6761
Mailing Address - Fax:907-562-8587
Practice Address - Street 1:2401 E 42ND AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5205
Practice Address - Country:US
Practice Address - Phone:907-563-6761
Practice Address - Fax:907-562-8587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK395111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK161023Medicare PIN