Provider Demographics
NPI:1407054687
Name:BRENNAN CHIROPRACTIC HEALTH CENTER
Entity Type:Organization
Organization Name:BRENNAN CHIROPRACTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/ CHIROPRACTO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-261-5100
Mailing Address - Street 1:13754 1ST ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308-9337
Mailing Address - Country:US
Mailing Address - Phone:763-261-5100
Mailing Address - Fax:763-261-5100
Practice Address - Street 1:13754 1ST ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BECKER
Practice Address - State:MN
Practice Address - Zip Code:55308-9337
Practice Address - Country:US
Practice Address - Phone:763-261-5100
Practice Address - Fax:763-261-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN516528800Medicaid
MNC06608OtherMEDICARE GROUP NUMBER
MNU25847Medicare UPIN
MN359000224Medicare PIN