Healthcare Provider Details

I. General information

NPI: 1295970176
Provider Name (Legal Business Name): CASEY CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 EL CAJON BLVD
SAN DIEGO CA
92104-1105
US

IV. Provider business mailing address

2301 EL CAJON BLVD
SAN DIEGO CA
92104-1105
US

V. Phone/Fax

Practice location:
  • Phone: 619-269-9909
  • Fax: 619-269-6906
Mailing address:
  • Phone: 619-269-9909
  • Fax: 619-269-6906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. BEAU EMMETT CASEY
Title or Position: OWNER/CHIROPRACTOR
Credential: D.C.
Phone: 619-269-9909