Healthcare Provider Details

I. General information

NPI: 1679802227
Provider Name (Legal Business Name): BRETT GUIMARD D.C., LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 OLYMPIC PKWY
CHULA VISTA CA
91915-6007
US

IV. Provider business mailing address

2800 OLYMPIC PKWY
CHULA VISTA CA
91915-6007
US

V. Phone/Fax

Practice location:
  • Phone: 619-213-7743
  • Fax:
Mailing address:
  • Phone: 619-213-7743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number30512
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number12468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: