Provider Demographics
NPI:1669432191
Name:BRANNEN, REGINALD R (DC)
Entity type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:R
Last Name:BRANNEN
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 1:530 HOWELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-2000
Mailing Address - Country:US
Mailing Address - Phone:864-268-8196
Mailing Address - Fax:864-268-8198
Practice Address - Street 1:530 HOWELL RD STE 100
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-2000
Practice Address - Country:US
Practice Address - Phone:864-268-8196
Practice Address - Fax:864-268-8198
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU780887277Medicare PIN
SCU78088Medicare UPIN