Healthcare Provider Details

I. General information

NPI: 1013092162
Provider Name (Legal Business Name): MARK ANTHONY BRENNER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 TROOP DRIVE SUITE 201
SARTELL MN
56377-4637
US

IV. Provider business mailing address

2380 TROOP DRIVE SUITE 201
SARTELL MN
56377-4637
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-5599
  • Fax: 320-253-4585
Mailing address:
  • Phone: 320-252-5599
  • Fax: 320-253-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2229
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: