Healthcare Provider Details

I. General information

NPI: 1255528931
Provider Name (Legal Business Name): BRENDN JOHN O'BRIEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 N 3RD ST STE 107
MINNEAPOLIS MN
55401-1292
US

IV. Provider business mailing address

514 N 3RD ST STE 107
MINNEAPOLIS MN
55401-1292
US

V. Phone/Fax

Practice location:
  • Phone: 651-405-1000
  • Fax:
Mailing address:
  • Phone: 651-405-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4077
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: