Provider Demographics
NPI:1326066655
Name:BRENTS, KARYN SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:KARYN
Middle Name:SUE
Last Name:BRENTS
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 1:2337 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3504
Mailing Address - Country:US
Mailing Address - Phone:203-288-0607
Mailing Address - Fax:
Practice Address - Street 1:2337 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3504
Practice Address - Country:US
Practice Address - Phone:203-288-0607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004221769Medicaid
CT004221769Medicaid
CTU84599Medicare UPIN