Provider Demographics
NPI:1427489129
Name:VANNATTER, BRENDAN (DC)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:VANNATTER
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 1:231 ROUTE 28 APT 5
Mailing Address - Street 2:
Mailing Address - City:WEST HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02671-1219
Mailing Address - Country:US
Mailing Address - Phone:774-408-8218
Mailing Address - Fax:
Practice Address - Street 1:231 ROUTE 28 APT 5
Practice Address - Street 2:
Practice Address - City:WEST HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02671-1219
Practice Address - Country:US
Practice Address - Phone:774-408-8218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor