Provider Demographics
NPI:1487676680
Name:MCCONNELL, BRENT (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:
Last Name:MCCONNELL
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 1:177 MAIN STREET
Mailing Address - Street 2:PO BOX 638
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-0638
Mailing Address - Country:US
Mailing Address - Phone:724-588-8880
Mailing Address - Fax:724-588-1515
Practice Address - Street 1:177 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-2145
Practice Address - Country:US
Practice Address - Phone:724-588-8880
Practice Address - Fax:724-588-1515
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000786524OtherHIGHMARK ID
PA251869764OtherTAX ID
PA251869764OtherTAX ID