Provider Demographics
NPI:1689747305
Name:ALLAN, BRETT KELLETT SR (DC)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:KELLETT
Last Name:ALLAN
Suffix:SR
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 1:3980 LAGO DI GRATA CIR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-8601
Mailing Address - Country:US
Mailing Address - Phone:858-259-0553
Mailing Address - Fax:858-259-0518
Practice Address - Street 1:9610 GRANITE RIDGE DR
Practice Address - Street 2:SUITE C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2684
Practice Address - Country:US
Practice Address - Phone:858-573-0550
Practice Address - Fax:858-573-0551
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC166667111N00000X
IL038010241111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor