Provider Demographics
NPI:1083765846
Name:STEVEN MARC BRETOW
Entity Type:Organization
Organization Name:STEVEN MARC BRETOW
Other - Org Name:WESTSIDE FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:BRETOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:510-843-5700
Mailing Address - Street 1:2560 9TH ST
Mailing Address - Street 2:SUITE 313
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2500
Mailing Address - Country:US
Mailing Address - Phone:510-843-5700
Mailing Address - Fax:510-843-0190
Practice Address - Street 1:2560 9TH ST
Practice Address - Street 2:SUITE 313
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2500
Practice Address - Country:US
Practice Address - Phone:510-843-5700
Practice Address - Fax:510-843-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty