Provider Demographics
NPI:1841403391
Name:BRENNAN, MICHAEL
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 MCCOMAS WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-3916
Mailing Address - Country:US
Mailing Address - Phone:757-430-8000
Mailing Address - Fax:757-427-2267
Practice Address - Street 1:2105 MCCOMAS WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-3916
Practice Address - Country:US
Practice Address - Phone:757-430-8000
Practice Address - Fax:757-427-2267
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV20108Medicare UPIN
VA350001269Medicare PIN