MEDICARE: DR. RUSSELL BRENNER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X012276-1	NY

General Provider Information

NPI Number	:	1245576149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL BRENNER D.C.

Provider Business Mailing Address
First Line	:	1010 SUNRISE HWY
Second Line	:
City	:	ROCKVILLE CENTRE
State	:	NY
Zip	:	11570-5100
Country	:	US
Telephone Number	:	516-224-7579
Fax Number	:

Provider Business Practice Location Address
First Line	:	2468 N JERUSALEM RD STE 15
Second Line	:
City	:	NORTH BELLMORE
State	:	NY
Zip	:	11710-1122
Country	:	US
Telephone Number	:	516-208-6123
Fax Number	:	516-208-6122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2012
Last Update Date	:	07/08/2023

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