Provider Demographics
NPI:1710083795
Name:GARRETT, BRIAN T (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:T
Last Name:GARRETT
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 1:1901 1ST AVE
Mailing Address - Street 2:STE 245
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-0311
Mailing Address - Country:US
Mailing Address - Phone:619-232-2225
Mailing Address - Fax:619-795-2619
Practice Address - Street 1:1901 1ST AVE
Practice Address - Street 2:STE 245
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-0311
Practice Address - Country:US
Practice Address - Phone:619-232-2225
Practice Address - Fax:619-795-2619
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17686OtherSTATE LICENSE NUMBER