Healthcare Provider Details

I. General information

NPI: 1447389069
Provider Name (Legal Business Name): DENNIS WAYNE TSO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6540 LUSK BLVD STE C148
SAN DIEGO CA
92121-2767
US

IV. Provider business mailing address

6540 LUSK BLVD STE C148
SAN DIEGO CA
92121-2767
US

V. Phone/Fax

Practice location:
  • Phone: 858-658-0424
  • Fax: 888-826-6928
Mailing address:
  • Phone: 858-658-0424
  • Fax: 888-826-6928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC-29858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: