Provider Demographics
NPI:1467458489
Name:ROONEY, BRENDA LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:LEE
Last Name:ROONEY
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 1:22 PLAZA RD
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-9416
Mailing Address - Country:US
Mailing Address - Phone:908-852-2545
Mailing Address - Fax:
Practice Address - Street 1:22 PLAZA RD
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-9416
Practice Address - Country:US
Practice Address - Phone:908-852-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00605000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ076617OtherMEDICARE ID-TYPE UNSPECIFIED
NJ076618OtherMEDICARE ID - TYPE UNSPEC
NJ076617OtherMEDICARE ID-TYPE UNSPECIFIED