Provider Demographics
NPI:1407252208
Name:BRENNAN, RYAN ANDREW (DC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:ANDREW
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6168 ROUTE 209
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-7633
Mailing Address - Country:US
Mailing Address - Phone:570-801-6444
Mailing Address - Fax:
Practice Address - Street 1:6168 ROUTE 209
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-7633
Practice Address - Country:US
Practice Address - Phone:570-801-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor