Provider Demographics
NPI:1013031236
Name:STINE, BRETT W (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:W
Last Name:STINE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ANDRIEUX ST
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6906
Mailing Address - Country:US
Mailing Address - Phone:707-996-4535
Mailing Address - Fax:707-996-8510
Practice Address - Street 1:101 ANDRIEUX ST
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6906
Practice Address - Country:US
Practice Address - Phone:707-996-4535
Practice Address - Fax:707-996-8510
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0277040OtherPIN