Provider Demographics
NPI:1013299478
Name:BRENEMAN, MICHAEL THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:BRENEMAN
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 1:18619 HERON CT
Mailing Address - Street 2:18619 HERON CT
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-5924
Mailing Address - Country:US
Mailing Address - Phone:360-913-3116
Mailing Address - Fax:
Practice Address - Street 1:18619 HERON CT
Practice Address - Street 2:18619 HERON CT
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-5924
Practice Address - Country:US
Practice Address - Phone:360-913-3116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001293111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology