Provider Demographics
NPI:1598857013
Name:DECLERK, BRIAN JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOSEPH
Last Name:DECLERK
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 1:3529 CANNON RD STE 2E
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4979
Mailing Address - Country:US
Mailing Address - Phone:760-631-8000
Mailing Address - Fax:760-631-8099
Practice Address - Street 1:3529 CANNON RD STE 2E
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4979
Practice Address - Country:US
Practice Address - Phone:760-631-8000
Practice Address - Fax:760-631-8099
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA931150OtherQME
CADC17664Medicare ID - Type Unspecified