MEDICARE: DR. ZACHARY RICHARD HOMER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	8590	AZ

General Provider Information

NPI Number	:	1912461872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZACHARY RICHARD HOMER DC

Provider Business Mailing Address
First Line	:	1166 E WARNER RD STE 101C
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-3065
Country	:	US
Telephone Number	:	480-339-7142
Fax Number	:

Provider Business Practice Location Address
First Line	:	1166 E WARNER RD STE 101C
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-3065
Country	:	US
Telephone Number	:	480-339-7142
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2019
Last Update Date	:	01/07/2021

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