Provider Demographics
NPI:1518382969
Name:CHEN, BRIAN (DC, LAC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:CHEN
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 1:15923 BEAR VALLEY RD STE A210
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-1787
Mailing Address - Country:US
Mailing Address - Phone:760-244-7373
Mailing Address - Fax:760-244-7676
Practice Address - Street 1:15923 BEAR VALLEY RD STE A210
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1787
Practice Address - Country:US
Practice Address - Phone:760-244-7373
Practice Address - Fax:760-244-7676
Is Sole Proprietor?:No
Enumeration Date:2014-02-21
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32793111N00000X
CA16159171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA454445289OtherEIN