Provider Demographics
NPI:1770706723
Name:BRETOW, GARY ROY (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:ROY
Last Name:BRETOW
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 1:3737 MORAGA AVE
Mailing Address - Street 2:STE A3
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5486
Mailing Address - Country:US
Mailing Address - Phone:619-276-7575
Mailing Address - Fax:619-276-6362
Practice Address - Street 1:3737 MORAGA AVE
Practice Address - Street 2:STE A3
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5486
Practice Address - Country:US
Practice Address - Phone:858-755-1885
Practice Address - Fax:619-276-6362
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor