Provider Demographics
NPI:1982023198
Name:DEAN, SAMANTHA NICHOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:NICHOLE
Last Name:DEAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 GRAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2370
Mailing Address - Country:US
Mailing Address - Phone:760-214-9157
Mailing Address - Fax:760-797-1845
Practice Address - Street 1:785 GRAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2370
Practice Address - Country:US
Practice Address - Phone:760-214-9157
Practice Address - Fax:760-797-1845
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32824111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor