Healthcare Provider Details

I. General information

NPI: 1407956220
Provider Name (Legal Business Name): DALE EDWARD BRACH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443 6TH ST
GUSTINE CA
95322-1520
US

IV. Provider business mailing address

443 6TH ST
GUSTINE CA
95322-1520
US

V. Phone/Fax

Practice location:
  • Phone: 209-854-2437
  • Fax: 209-854-2437
Mailing address:
  • Phone: 209-854-2437
  • Fax: 209-854-2437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number18339
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: