Provider Demographics
NPI:1942739545
Name:WS BRENNION DC CHIROPRACTOR
Entity Type:Organization
Organization Name:WS BRENNION DC CHIROPRACTOR
Other - Org Name:BRENNION CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BRENNION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-356-0876
Mailing Address - Street 1:5407 HARDING PIKE STE B
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2838
Mailing Address - Country:US
Mailing Address - Phone:615-356-0876
Mailing Address - Fax:
Practice Address - Street 1:5407 HARDING PIKE STE B
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2838
Practice Address - Country:US
Practice Address - Phone:615-356-0876
Practice Address - Fax:615-356-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3672020Medicaid
TN2004536OtherBCBST