Provider Demographics
NPI:1457817835
Name:GOLDEN, SEAN PATRICK (DC)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:PATRICK
Last Name:GOLDEN
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 1:11199 SORRENTO VALLEY RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1334
Mailing Address - Country:US
Mailing Address - Phone:858-768-6111
Mailing Address - Fax:858-768-6116
Practice Address - Street 1:11199 SORRENTO VALLEY RD STE 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1334
Practice Address - Country:US
Practice Address - Phone:858-768-6111
Practice Address - Fax:858-768-6116
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC34420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty