Provider Demographics
NPI:1316385909
Name:KEITH A BRENNAN DC PLLC
Entity Type:Organization
Organization Name:KEITH A BRENNAN DC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-254-3303
Mailing Address - Street 1:45280 CASS AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5600
Mailing Address - Country:US
Mailing Address - Phone:586-254-3303
Mailing Address - Fax:206-337-9141
Practice Address - Street 1:45280 CASS AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5600
Practice Address - Country:US
Practice Address - Phone:586-254-3303
Practice Address - Fax:206-337-9141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty