Provider Demographics
NPI:1609854827
Name:MEDINA, BRENDA LEE (DC)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:LEE
Last Name:MEDINA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 HOLIDAY CT STE 206
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-1301
Mailing Address - Country:US
Mailing Address - Phone:615-719-6131
Mailing Address - Fax:615-261-9179
Practice Address - Street 1:133 HOLIDAY CT STE 206
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-1301
Practice Address - Country:US
Practice Address - Phone:615-719-6131
Practice Address - Fax:615-261-9179
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2286111N00000X
TNDC0000002286111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty