| Name: | Brandon Clinic, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 08 Oct 1999 (25 years ago) (Companies founded in October 1999) |
| Entity Number: | 000-666-613 |
| Register Number: | 000666613 |
| Place of Formation: | Jefferson County |
| Principal Address: | GARDENDALE, AL |
| Registered Office Street Address: | 600 MAIN ST #107GARDENDALE, AL 35701 |
Activities
PROFESSIONAL CHIROPRACTIC SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467518217 | 2006-12-28 | 2008-06-16 | PO BOX 1043, 600 MAIN STREET SUITE 107, GARDENDALE, AL, 350711043, US | 600 MAIN ST STE 107, GARDENDALE, AL, 350713649, US | |||||||||||||||||||||||||
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| Phone | +1 205-631-8808 |
| Fax | 2056318832 |
Authorized person
| Name | DR. RONALD DAVID BRANDON |
| Role | MANAGER OWNER PRES |
| Phone | 2056318808 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | 0884 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD OF ALABAMA |
| Number | 51096028 |
| State | AL |
| Name | Role |
|---|---|
| BRANDON, RONALD D | Member |
| Name | Role |
|---|---|
| BRANDON, RONALD D | Agent |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
