Provider Demographics
NPI:1477608180
Name:PENNINGTON, BRETT ALAN (DC)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:ALAN
Last Name:PENNINGTON
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 1:204 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-2816
Mailing Address - Country:US
Mailing Address - Phone:785-827-8727
Mailing Address - Fax:785-827-8796
Practice Address - Street 1:204 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-2816
Practice Address - Country:US
Practice Address - Phone:785-827-8727
Practice Address - Fax:785-827-8796
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS014155Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
KSU34590Medicare UPIN
KS014157Medicare ID - Type Unspecified