Provider Demographics
NPI:1356339022
Name:BRENNEMAN, GLENN A JR (DC)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:A
Last Name:BRENNEMAN
Suffix:JR
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 1:156 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4423
Mailing Address - Country:US
Mailing Address - Phone:724-223-0500
Mailing Address - Fax:724-222-3412
Practice Address - Street 1:156 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4423
Practice Address - Country:US
Practice Address - Phone:724-223-0500
Practice Address - Fax:724-222-3412
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004643L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA213362OtherUPMC
U62343Medicare UPIN
PA213362OtherUPMC