Provider Demographics
NPI:1558446542
Name:BRENNAN, TERESA (DC)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:BRENNAN
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 1:5010 WINSHIP CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-1371
Mailing Address - Country:US
Mailing Address - Phone:678-297-2949
Mailing Address - Fax:
Practice Address - Street 1:4705 S CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-4103
Practice Address - Country:US
Practice Address - Phone:386-763-2729
Practice Address - Fax:386-763-2729
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002503111N00000X
FLCFC6111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA581932581OtherTAX ID NUMBER
GAU22209Medicare UPIN