Provider Demographics
NPI:1902014970
Name:BRIGHTWELL, TERRY
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:BRIGHTWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 JAMACHA RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-2366
Mailing Address - Country:US
Mailing Address - Phone:619-444-3191
Mailing Address - Fax:
Practice Address - Street 1:236 JAMACHA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-2366
Practice Address - Country:US
Practice Address - Phone:619-444-3191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor