Provider Demographics
NPI:1124144605
Name:KILLEEN, BRIAN T (DC QME)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:T
Last Name:KILLEEN
Suffix:
Gender:M
Credentials:DC QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2564 STATE ST
Mailing Address - Street 2:PLAZA FLORES SUITE A
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008
Mailing Address - Country:US
Mailing Address - Phone:760-434-8134
Mailing Address - Fax:760-434-3370
Practice Address - Street 1:2564 STATE ST
Practice Address - Street 2:PLAZA FLORES SUITE A
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008
Practice Address - Country:US
Practice Address - Phone:760-434-8134
Practice Address - Fax:760-434-3370
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15271111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor