Provider Demographics
NPI:1457870560
Name:YEO, BRANDEN GUTLAY (DC)
Entity Type:Individual
Prefix:
First Name:BRANDEN
Middle Name:GUTLAY
Last Name:YEO
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 1:1510 FRONT ST STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2945
Mailing Address - Country:US
Mailing Address - Phone:858-375-6794
Mailing Address - Fax:
Practice Address - Street 1:239 S LA CIENEGA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3319
Practice Address - Country:US
Practice Address - Phone:310-880-1659
Practice Address - Fax:866-509-1539
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor