Provider Demographics
NPI:1225368533
Name:ZAMORA, BRYANT NOEL (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYANT
Middle Name:NOEL
Last Name:ZAMORA
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 1:642 3RD AVE STE F
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5733
Mailing Address - Country:US
Mailing Address - Phone:619-427-7030
Mailing Address - Fax:619-427-1428
Practice Address - Street 1:642 3RD AVE STE F
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5733
Practice Address - Country:US
Practice Address - Phone:619-427-7030
Practice Address - Fax:619-427-1428
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20449111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor