Healthcare Provider Details

I. General information

NPI: 1548266711
Provider Name (Legal Business Name): BRENT DAVID VENABLES D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 19TH ST S STE 101
SARTELL MN
56377-2555
US

IV. Provider business mailing address

161 19TH ST S STE 101
SARTELL MN
56377-4579
US

V. Phone/Fax

Practice location:
  • Phone: 320-257-0360
  • Fax: 320-253-9968
Mailing address:
  • Phone: 320-203-7115
  • Fax: 320-257-9968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3592
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number434
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: