Healthcare Provider Details

I. General information

NPI: 1790198943
Provider Name (Legal Business Name): LUKE BRENNAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2408 S MAIN ST STE A
MARYVILLE MO
64468-3624
US

IV. Provider business mailing address

3949 SHERMAN AVE
SAINT JOSEPH MO
64506-3649
US

V. Phone/Fax

Practice location:
  • Phone: 660-582-4357
  • Fax: 866-236-7931
Mailing address:
  • Phone: 816-387-8994
  • Fax: 816-387-8220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2014016679
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: