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DR. BRANDON ANTONISSEN DC

>> Chiropractor >> Chiropractic Providers

Registrant NPI Number: 1063991354

Individual Registrant:
DR. BRANDON  ANTONISSEN DC
Gender: M
Sole Proprietor

Location and contact information for practice:
5 JOURNEY STE 100  ALISO VIEJO, CA 92656-5330 US
Tel: 949-228-1147  Fax: --

Contact information for business:
1968 S COAST HWY STE 1073 LAGUNA BEACH, CA 92651-3681 US
Tel: 949-228-1147  Fax: --

Registration Information:
NPI: 1063991354
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y111N00000XChiropractic Providers
Chiropractor
CA34287

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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