Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHR.0007527 | CO |
N | 111NR0400X | Rehabilitation Chiropractor | EL.2786593 | CO |
NPI | 1104368596 |
---|---|
Provider Name | Brittany Maclennan |
First Address | Troy, MI 48085-4905 |
Second Address | Troy, MI 48085-4905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2016 |
Last Update Date | 06/12/2016 |