Provider Demographics
NPI:1841495900
Name:BRENNAN CHIROPRACTIC PC
Entity type:Organization
Organization Name:BRENNAN CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-430-8000
Mailing Address - Street 1:2129 GENERAL BOOTH BLVD
Mailing Address - Street 2:STE 115
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5872
Mailing Address - Country:US
Mailing Address - Phone:757-430-8000
Mailing Address - Fax:757-427-2267
Practice Address - Street 1:2129 GENERAL BOOTH BLVD
Practice Address - Street 2:STE 115
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5872
Practice Address - Country:US
Practice Address - Phone:757-430-8000
Practice Address - Fax:757-427-2267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08372Medicare PIN