Provider Demographics
NPI:1922060912
Name:BRENNAN, MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-1344
Mailing Address - Country:US
Mailing Address - Phone:270-692-2652
Mailing Address - Fax:270-692-6099
Practice Address - Street 1:303 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-1344
Practice Address - Country:US
Practice Address - Phone:270-692-2652
Practice Address - Fax:270-692-6099
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85003184Medicaid
KYV00158Medicare UPIN
KY85003184Medicaid