Provider Demographics
NPI:1164623526
Name:BRENNEMAN CHIROPRACTIC PC
Entity Type:Organization
Organization Name:BRENNEMAN CHIROPRACTIC PC
Other - Org Name:CROSSROADS CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-223-0500
Mailing Address - Street 1:156 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4423
Mailing Address - Country:US
Mailing Address - Phone:724-223-0500
Mailing Address - Fax:724-222-3412
Practice Address - Street 1:156 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4423
Practice Address - Country:US
Practice Address - Phone:724-223-0500
Practice Address - Fax:724-222-3412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004643L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001914251Medicaid
PA001586535Medicaid
PAU62343Medicare UPIN
PABR196404Medicare ID - Type Unspecified
PAU91604Medicare UPIN
PA001914251Medicaid