Provider Demographics
NPI:1912203456
Name:JAMIE L BRENON DC PLLC
Entity Type:Organization
Organization Name:JAMIE L BRENON DC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-837-1711
Mailing Address - Street 1:1088 BRIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-8309
Mailing Address - Country:US
Mailing Address - Phone:716-837-1711
Mailing Address - Fax:
Practice Address - Street 1:1088 BRIGHTON RD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-8309
Practice Address - Country:US
Practice Address - Phone:716-837-1711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty