Provider Demographics
NPI:1588780241
Name:O'BRIEN, DENNIS JOSEPH (DC, QME)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:JOSEPH
Last Name:O'BRIEN
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 1:1392 E PALOMAR ST
Mailing Address - Street 2:SUITE 403-132
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1892
Mailing Address - Country:US
Mailing Address - Phone:619-565-2900
Mailing Address - Fax:619-934-9036
Practice Address - Street 1:209 LANDIS AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2608
Practice Address - Country:US
Practice Address - Phone:619-565-2900
Practice Address - Fax:619-934-9036
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA24245Medicare UPIN