Envive Brandon Prof LLC

NPI #1023502168 in Brandon, South Dakota

Provider Information

NPI Number: 1023502168
Entity Type: Organization
Organization Name: Envive Brandon Prof LLC
Subpart: Yes (part of a larger organization)
Parent Organization: ENVIVE, P.C.
Primary Specialty: Chiropractor
Enumeration Date: Jun 21, 2018
Last Updated: Sep 13, 2018

Practice Location

Address: 220 E HOLLY BLVD
City: Brandon
State: South Dakota
ZIP Code: 57005-1171
Phone: (605) 582-3944

Authorized Official

Name: LAVONNE MCKEE
Title: CREDENTIALING SPECIALIST
Phone: (605) 214-1401

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Chiropractor	111N00000X	Primary

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