Provider Demographics
NPI:1093813396
Name:CORCORAN, BRENDAN PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:PATRICK
Last Name:CORCORAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:121 MAPLEWOOD AVE
Mailing Address - Street 2:UNIT #2
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-2659
Mailing Address - Country:US
Mailing Address - Phone:617-846-3502
Mailing Address - Fax:617-846-6899
Practice Address - Street 1:11 BARTLETT RD
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-2912
Practice Address - Country:US
Practice Address - Phone:617-846-3502
Practice Address - Fax:617-846-6899
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2851111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACO Y45748Medicare PIN