Provider Demographics
NPI:1568454536
Name:BRENNAN, JOHN TAYLOR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TAYLOR
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1390 W H ST
Mailing Address - Street 2:STE C
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3529
Mailing Address - Country:US
Mailing Address - Phone:209-847-8731
Mailing Address - Fax:209-847-2291
Practice Address - Street 1:1390 W H ST
Practice Address - Street 2:STE C
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3529
Practice Address - Country:US
Practice Address - Phone:209-847-8731
Practice Address - Fax:209-847-2291
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA17443111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT06475Medicare UPIN
CADC0174430Medicare ID - Type Unspecified