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General NPI Number Information
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NPI Number | 1093813396
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Entity Type | Individual
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Provider Name | BRENDAN PATRICK CORCORAN D.C.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | 11 BARTLETT RD
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City | WINTHROP
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State | MA
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Zip | 02152-2912
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Country | US
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Telephone | 617-846-3502
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Fax | 617-846-6899
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Provider Business Mailing Address
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Address Line | 121 MAPLEWOOD AVE UNIT #2
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City | GLOUCESTER
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State | MA
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Zip | 01930-2659
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Country | US
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Telephone | 617-846-3502
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Fax | 617-846-6899
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2851
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License Number State | MA
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