Provider Demographics
NPI:1407956220
Name:BRACH, DALE EDWARD (DC)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:EDWARD
Last Name:BRACH
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 1:443 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GUSTINE
Mailing Address - State:CA
Mailing Address - Zip Code:95322-1520
Mailing Address - Country:US
Mailing Address - Phone:209-854-2437
Mailing Address - Fax:209-854-2437
Practice Address - Street 1:443 6TH ST
Practice Address - Street 2:
Practice Address - City:GUSTINE
Practice Address - State:CA
Practice Address - Zip Code:95322-1520
Practice Address - Country:US
Practice Address - Phone:209-854-2437
Practice Address - Fax:209-854-2437
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC018339Medicare ID - Type Unspecified