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Individual

BRANDON CHURCH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MS, LAT, ATC

Contact information

Practice address
1010 S GREENE ST, ROCK RAPIDS, IA 51246-2087
(507) 210-8493
Mailing address
1010 S GREENE ST, ROCK RAPIDS, IA 51246-2087
(507) 210-8493

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
0639
SD
2255A2300X
Athletic Trainer
Primary
097122
IA
2255A2300X
Athletic Trainer
3015
MN
2255A2300X
Athletic Trainer

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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