Provider Demographics
NPI:1427600600
Name:BRENNEMAN, ALEXANDER (DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:BRENNEMAN
Suffix:
Gender:M
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W CESSNA DR APT 1
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-7805
Mailing Address - Country:US
Mailing Address - Phone:765-265-9808
Mailing Address - Fax:
Practice Address - Street 1:4721 N WHEELING AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-1222
Practice Address - Country:US
Practice Address - Phone:765-286-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000205A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist