Provider Demographics
NPI:1053719591
Name:COOLEY, BRANDON MARK-DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:MARK-DOUGLAS
Last Name:COOLEY
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 1:809 W GANSON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-4202
Mailing Address - Country:US
Mailing Address - Phone:517-990-8858
Mailing Address - Fax:
Practice Address - Street 1:809 W GANSON ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-4202
Practice Address - Country:US
Practice Address - Phone:517-990-8858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor