Provider Demographics
NPI:1659697597
Name:BREEN CHIROPRACTIC CLINIC, PC
Entity Type:Organization
Organization Name:BREEN CHIROPRACTIC CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:BREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-368-4040
Mailing Address - Street 1:8565 SUDLEY RD STE A
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-3864
Mailing Address - Country:US
Mailing Address - Phone:703-368-4040
Mailing Address - Fax:703-361-1177
Practice Address - Street 1:8565 SUDLEY RD STE A
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-3864
Practice Address - Country:US
Practice Address - Phone:703-368-4040
Practice Address - Fax:703-361-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000765111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty