Provider Demographics
NPI:1689295081
Name:RODEN, BRENNA RENEE (DC)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:RENEE
Last Name:RODEN
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 1:1685 MARS HILL RD NW STE 103
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-7180
Mailing Address - Country:US
Mailing Address - Phone:770-218-0400
Mailing Address - Fax:770-218-1160
Practice Address - Street 1:1685 MARS HILL RD NW STE 103
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-7180
Practice Address - Country:US
Practice Address - Phone:770-218-0400
Practice Address - Fax:770-218-1160
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor