Provider Demographics
NPI:1487738563
Name:ALLAN, BRETT KELLETT JR (DC)
Entity type:Individual
Prefix:MR
First Name:BRETT
Middle Name:KELLETT
Last Name:ALLAN
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:3980 LAGO DI GRATA CIR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-8601
Mailing Address - Country:US
Mailing Address - Phone:619-990-0543
Mailing Address - Fax:
Practice Address - Street 1:9610 GRANITE RIDGE DR
Practice Address - Street 2:SUITE C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2684
Practice Address - Country:US
Practice Address - Phone:858-573-0550
Practice Address - Fax:858-573-0551
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2011-11-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CADC30273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor