Provider Demographics
NPI:1811459738
Name:NEILL, GARRETT (DC)
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:
Last Name:NEILL
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 1:4299 MACARTHUR BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2019
Mailing Address - Country:US
Mailing Address - Phone:949-851-5900
Mailing Address - Fax:
Practice Address - Street 1:4299 MACARTHUR BLVD STE 102
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2019
Practice Address - Country:US
Practice Address - Phone:949-851-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33537111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician