Provider Demographics
NPI:1548266711
Name:VENABLES, BRENT DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:DAVID
Last Name:VENABLES
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 1:161 19TH ST S
Mailing Address - Street 2:STE 101
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4579
Mailing Address - Country:US
Mailing Address - Phone:320-203-7115
Mailing Address - Fax:320-257-9968
Practice Address - Street 1:161 19TH ST S STE 101
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2555
Practice Address - Country:US
Practice Address - Phone:320-257-0360
Practice Address - Fax:320-253-9968
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN434171100000X
MN3592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN284T4VEOtherBCBS
MN350055945OtherRAIL ROAD MEDICARE
MN822520600Medicaid
MN350002649Medicare PIN
MN350055945OtherRAIL ROAD MEDICARE