Provider Demographics
NPI:1922069871
Name:BRENNAN, TIMOTHY JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOSEPH
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 1:650 E MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17003
Mailing Address - Country:US
Mailing Address - Phone:717-867-3031
Mailing Address - Fax:
Practice Address - Street 1:648 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:PA
Practice Address - Zip Code:17003
Practice Address - Country:US
Practice Address - Phone:717-867-4000
Practice Address - Fax:717-867-2177
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004495L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02825800OtherBLUE CROSS
PABR587877OtherBLUE SHIELD
PA02825800OtherBLUE CROSS
T91205Medicare UPIN