Provider Demographics
NPI:1376987701
Name:BRAINTEK INSTITUTE
Entity Type:Organization
Organization Name:BRAINTEK INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MANESS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-735-4888
Mailing Address - Street 1:3978 SORRENTO VALLEY BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1436
Mailing Address - Country:US
Mailing Address - Phone:858-735-4888
Mailing Address - Fax:858-385-0222
Practice Address - Street 1:3978 SORRENTO VALLEY BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1436
Practice Address - Country:US
Practice Address - Phone:858-735-4888
Practice Address - Fax:858-385-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2457 BCN101YA0400X, 103K00000X, 103T00000X, 111NR0400X, 172M00000X, 174400000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2457 BCNOtherBOARD CERTIFIED NEUROTHERAPIST