Active NPI
Brandon Lee Nissen, DC
- Chiropractor
- Antioch, CA
National Provider Identifier
1508565169
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC36545
- Practice address
- 3381 Deer Valley Rd
Antioch, CA 94531-6664 - Phone
- (925) 757-7571
- Fax
- (925) 757-7114
- NPI assigned
- Mar 2, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC36545 | ID | Primary |
Addresses
Primary practice location
3381 Deer Valley Rd
Antioch, CA 94531-6664
Mailing address
1342 E Covey Run CT
Eagle, ID 83616-4273
Phone (925) 584-8166
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC36545 | ID | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eagle Cramer Chiropractic, P.a. | Chiropractor | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Chiropractor
- Eagle, ID
- NPI 1679642888
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1677715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705276800000",
"number": "1508565169",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1342 E COVEY RUN CT",
"city": "EAGLE",
"state": "ID",
"postal_code": "836164273",
"telephone_number": "925-584-8166"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3381 DEER VALLEY RD",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945316664",
"telephone_number": "925-757-7571",
"fax_number": "925-757-7114"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NISSEN",
"first_name": "BRANDON",
"middle_name": "LEE",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-03-02",
"last_updated": "2024-01-15",
"certification_date": "2024-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "ID",
"license": "DC36545",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Antioch, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.