Provider Demographics
NPI:1619041654
Name:BRINEGAR, KENNETH DEAN (DC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:DEAN
Last Name:BRINEGAR
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 1:8760 CUYAMACA ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-6210
Mailing Address - Country:US
Mailing Address - Phone:619-258-1011
Mailing Address - Fax:619-258-1023
Practice Address - Street 1:8760 CUYAMACA ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-6210
Practice Address - Country:US
Practice Address - Phone:619-258-1011
Practice Address - Fax:619-258-1023
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU82666Medicare UPIN