Provider Demographics
NPI:1245402502
Name:BRERETON, TRICIA ADELINE (DC)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:ADELINE
Last Name:BRERETON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E PITMAN ST
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2619
Mailing Address - Country:US
Mailing Address - Phone:636-272-4625
Mailing Address - Fax:636-240-3522
Practice Address - Street 1:110 E PITMAN ST
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2619
Practice Address - Country:US
Practice Address - Phone:636-272-4625
Practice Address - Fax:636-240-3522
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008000409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor