Provider Demographics
NPI:1902170434
Name:BRAITHWAITE, SEAN MARTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:MARTIN
Last Name:BRAITHWAITE
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 1:6850 E SEPTIMO ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-5018
Mailing Address - Country:US
Mailing Address - Phone:562-522-1463
Mailing Address - Fax:
Practice Address - Street 1:12501 SEAL BEACH BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-2763
Practice Address - Country:US
Practice Address - Phone:562-596-6000
Practice Address - Fax:562-596-6040
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor