Provider Demographics
NPI:1538608245
Name:MAHONEY, BRENDAN (DC)
Entity type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:
Last Name:MAHONEY
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 1:544 STATE ROAD 559
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-9384
Mailing Address - Country:US
Mailing Address - Phone:314-262-9216
Mailing Address - Fax:
Practice Address - Street 1:605 OVERLOOK DR STE 1
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-1679
Practice Address - Country:US
Practice Address - Phone:863-318-9649
Practice Address - Fax:863-332-2240
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017001877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor