Provider Demographics
NPI:1619940939
Name:BRENNAN, BRIAN P (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:P
Last Name:BRENNAN
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 1:111 E GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-5623
Mailing Address - Country:US
Mailing Address - Phone:850-429-9911
Mailing Address - Fax:850-429-9933
Practice Address - Street 1:111 E GARDEN ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-5623
Practice Address - Country:US
Practice Address - Phone:850-429-9911
Practice Address - Fax:850-429-9933
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5559111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor