Healthcare Provider Details

I. General information

NPI: 1093972549
Provider Name (Legal Business Name): BRYAN GALE GATTERMAN D.C, D.A.C.B.R.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4061 E CASTRO VALLEY BLVD STE. 150
CASTRO VALLEY CA
94552-4840
US

IV. Provider business mailing address

4061 E CASTRO VALLEY BLVD STE. 150
CASTRO VALLEY CA
94552-4840
US

V. Phone/Fax

Practice location:
  • Phone: 925-803-1300
  • Fax: 925-828-3422
Mailing address:
  • Phone: 925-803-1300
  • Fax: 925-828-3422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberDC14920
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: