Provider Demographics
NPI:1225255839
Name:CASEY, GARRETT M (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:M
Last Name:CASEY
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22926 CERCA DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-2301
Mailing Address - Country:US
Mailing Address - Phone:818-378-2730
Mailing Address - Fax:818-387-4811
Practice Address - Street 1:24509 WALNUT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2846
Practice Address - Country:US
Practice Address - Phone:213-387-4710
Practice Address - Fax:213-387-4811
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2013-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC10407111N00000X
CAAC11811171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA107761Medicare UPIN