Healthcare Provider Details

I. General information

NPI: 1316082589
Provider Name (Legal Business Name): MICHAEL BRANDON ACKERMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 TORREY PINES RD SUITE G
LA JOLLA CA
92037-4504
US

IV. Provider business mailing address

1202 MORENA BLVD SUITE 200
SAN DIEGO CA
92110-3841
US

V. Phone/Fax

Practice location:
  • Phone: 619-687-7676
  • Fax: 866-831-4642
Mailing address:
  • Phone: 619-687-7676
  • Fax: 206-666-2585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC18296
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: