Provider Demographics
NPI:1972030344
Name:BRENNAN, DAN
Entity Type:Individual
Prefix:
First Name:DAN
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:LINDENWOOD UNIVERSITY
Mailing Address - Street 2:209 SOUTH KINGSHIGHWAY - HYLAND ARENA ATHLETIC TRAINING
Mailing Address - City:ST. CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LINDENWOOD UNIVERSITY 209 SOUTH KINGSHIGHWAY
Practice Address - Street 2:HYLAND ARENA
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-9998
Practice Address - Country:US
Practice Address - Phone:636-949-4365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer