MEDICARE: DR. BRENT DAVID VENABLES 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	171100000X	Acupuncturist	434	MN
2	111N00000X	Chiropractor	3592	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	350055945	OTHER	MN	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	284T4VE	OTHER	MN	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548266711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENT DAVID VENABLES D.C.

Provider Business Mailing Address
First Line	:	161 19TH ST S
Second Line	:	STE 101
City	:	SARTELL
State	:	MN
Zip	:	56377-4579
Country	:	US
Telephone Number	:	320-203-7115
Fax Number	:	320-257-9968

Provider Business Practice Location Address
First Line	:	161 19TH ST S STE 101
Second Line	:
City	:	SARTELL
State	:	MN
Zip	:	56377-2555
Country	:	US
Telephone Number	:	320-257-0360
Fax Number	:	320-253-9968

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	04/08/2019

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Directions to “ DR. BRENT DAVID VENABLES D.C.” Practice Location

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