Provider Demographics
NPI:1295871325
Name:MCKENNA, BRIAN JOESPH (LICAC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JOESPH
Last Name:MCKENNA
Suffix:
Gender:M
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 CHELSEA BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-6206
Mailing Address - Country:US
Mailing Address - Phone:713-942-9688
Mailing Address - Fax:713-942-9335
Practice Address - Street 1:716 CHELSEA BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-6206
Practice Address - Country:US
Practice Address - Phone:713-942-9688
Practice Address - Fax:713-942-9335
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00410171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist