Provider Demographics
NPI:1053420315
Name:BRENNAN, JOHN PATRICK (DC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PATRICK
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:P
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:13754 1ST STREET SE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308
Mailing Address - Country:US
Mailing Address - Phone:763-261-5100
Mailing Address - Fax:763-261-5100
Practice Address - Street 1:13754 1ST STREET SE
Practice Address - Street 2:SUITE #1
Practice Address - City:BECKER
Practice Address - State:MN
Practice Address - Zip Code:55308
Practice Address - Country:US
Practice Address - Phone:763-261-5100
Practice Address - Fax:763-261-5100
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3K679BROtherBCBSMN
MN3K680BROtherBCBSMN
MN3K679BROtherBCBSMN
C06608Medicare ID - Type UnspecifiedGROUP NUMBER