Provider Demographics
NPI:1962709303
Name:RANIELI, BRENNA BACON (DC, LLC)
Entity type:Individual
Prefix:DR
First Name:BRENNA
Middle Name:BACON
Last Name:RANIELI
Suffix:
Gender:F
Credentials:DC, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3157
Mailing Address - Country:US
Mailing Address - Phone:301-791-7111
Mailing Address - Fax:301-791-7119
Practice Address - Street 1:1329 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3157
Practice Address - Country:US
Practice Address - Phone:301-791-7111
Practice Address - Fax:301-791-7119
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03651111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor