Provider Demographics
NPI:1962565069
Name:BRENN, JAMES ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALAN
Last Name:BRENN
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 1:399 EAST ST CLAIR STREET
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-2440
Mailing Address - Country:US
Mailing Address - Phone:937-456-3070
Mailing Address - Fax:
Practice Address - Street 1:399 EAST ST CLAIR STREET
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-2440
Practice Address - Country:US
Practice Address - Phone:937-456-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36111N00000X
OH2755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T46395Medicare UPIN
BR0386021Medicare ID - Type Unspecified