Provider Demographics
NPI:1588641443
Name:PRIETO, BRIAN (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:PRIETO
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 1:17660 YORBA LINDA BLVD
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3927
Mailing Address - Country:US
Mailing Address - Phone:714-577-0200
Mailing Address - Fax:714-577-5730
Practice Address - Street 1:17660 YORBA LINDA BLVD
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3927
Practice Address - Country:US
Practice Address - Phone:714-577-0200
Practice Address - Fax:714-577-5730
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC22818Medicare ID - Type Unspecified
CAU56283Medicare UPIN