Individual
MR. BRANDT DERRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1155 W PARKVIEW ST STE 2D, BOLIVAR, MO 65613-7800
(417) 777-2663
(417) 326-2666
Mailing address
1500 N OAKLAND AVE, BOLIVAR, MO 65613-3011
(417) 326-6000
(417) 328-6338
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2016004534
MO
Other
Enumeration date
10/18/2016
Last updated
10/18/2016
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