Provider Demographics
NPI:1144535287
Name:BRENNAN, KEITH ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ALLEN
Last Name:BRENNAN
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 1:45280 CASS AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5600
Mailing Address - Country:US
Mailing Address - Phone:586-254-3303
Mailing Address - Fax:
Practice Address - Street 1:45280 CASS AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5600
Practice Address - Country:US
Practice Address - Phone:586-254-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor