Provider Demographics
NPI:1366779589
Name:UNDERWOOD, BRETT E (DC)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:E
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 OAKHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92823-6331
Mailing Address - Country:US
Mailing Address - Phone:714-588-6404
Mailing Address - Fax:
Practice Address - Street 1:3000 E BIRCH ST
Practice Address - Street 2:STE 110
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6261
Practice Address - Country:US
Practice Address - Phone:714-588-6404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor