Provider Demographics
NPI:1225350499
Name:BOOTH, BRIAN JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JAMES
Last Name:BOOTH
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 1:4030 BIRCH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2214
Mailing Address - Country:US
Mailing Address - Phone:949-752-5533
Mailing Address - Fax:949-752-5532
Practice Address - Street 1:4030 BIRCH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2214
Practice Address - Country:US
Practice Address - Phone:949-752-5533
Practice Address - Fax:949-752-5532
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor