Provider Demographics
NPI:1720544620
Name:QUINN, BRENNAN J (LAC)
Entity Type:Individual
Prefix:
First Name:BRENNAN
Middle Name:J
Last Name:QUINN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 W WARNER ST
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:54011-2706
Mailing Address - Country:US
Mailing Address - Phone:512-525-5185
Mailing Address - Fax:
Practice Address - Street 1:419 SAND LAKE RD
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-2706
Practice Address - Country:US
Practice Address - Phone:608-313-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-15
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01626171100000X
WI892-55171100000X
MN1927171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty