Provider Demographics
NPI:1538378450
Name:WRIGHT, SEAN KYLE (DC)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:KYLE
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3432 HILLCREST AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-6301
Mailing Address - Country:US
Mailing Address - Phone:925-757-3309
Mailing Address - Fax:925-705-4731
Practice Address - Street 1:3432 HILLCREST AVE
Practice Address - Street 2:STE 200
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-6301
Practice Address - Country:US
Practice Address - Phone:925-757-3309
Practice Address - Fax:925-705-4731
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27568111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0275680Medicare PIN