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Individual
BRANDON CHURCH
Active
Individual
BRANDON CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
0639
SD
2255A2300X
Athletic Trainer
Primary
097122
IA
2255A2300X
Athletic Trainer
3015
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0639
SOUTH DAKOTA BOARD OF MEDICAL AND OSTEOPATHIC EXAMINERS
SD
01
—
097122
IOWA DEPARTMENT OF PUBLIC HEALTH
IA
01
—
3015
MINNESOTA BOARD OF MEDICAL PRACTICE
MN
Enumeration date
01/14/2017
Last updated
07/27/2020
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