Provider Demographics
NPI:1811187966
Name:BATES, BRENT LAWRENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:LAWRENCE
Last Name:BATES
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 1:1611 S CATALINA AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5255
Mailing Address - Country:US
Mailing Address - Phone:310-540-5529
Mailing Address - Fax:310-540-3866
Practice Address - Street 1:1611 S CATALINA AVE
Practice Address - Street 2:STE 100
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5255
Practice Address - Country:US
Practice Address - Phone:310-540-5529
Practice Address - Fax:310-540-3866
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor