Healthcare Provider Details

I. General information

NPI: 1093813396
Provider Name (Legal Business Name): BRENDAN PATRICK CORCORAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 BARTLETT RD
WINTHROP MA
02152-2912
US

IV. Provider business mailing address

121 MAPLEWOOD AVE UNIT #2
GLOUCESTER MA
01930-2659
US

V. Phone/Fax

Practice location:
  • Phone: 617-846-3502
  • Fax: 617-846-6899
Mailing address:
  • Phone: 617-846-3502
  • Fax: 617-846-6899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2851
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: