Provider Demographics
NPI:1407988371
Name:DR BRIAN BRENNAN DC PA
Entity Type:Organization
Organization Name:DR BRIAN BRENNAN DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:I
Authorized Official - Credentials:DC
Authorized Official - Phone:850-429-9911
Mailing Address - Street 1:111 E GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-5623
Mailing Address - Country:US
Mailing Address - Phone:850-429-9911
Mailing Address - Fax:850-429-9933
Practice Address - Street 1:111 E GARDEN ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-5623
Practice Address - Country:US
Practice Address - Phone:850-429-9911
Practice Address - Fax:850-429-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5559111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT85306Medicare UPIN
FLAB485Medicare PIN