Provider Demographics
NPI:1134245483
Name:DIAZ, BRETT EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:EDWARD
Last Name:DIAZ
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 1:889 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-3420
Mailing Address - Country:US
Mailing Address - Phone:949-376-4142
Mailing Address - Fax:949-376-8182
Practice Address - Street 1:2537 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-6625
Practice Address - Country:US
Practice Address - Phone:909-930-2233
Practice Address - Fax:909-933-3775
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 18384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor