Healthcare Provider Details

I. General information

NPI: 1427129055
Provider Name (Legal Business Name): TONY R HILDEBRAND D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 S IRONWOOD DR
APACHE JUNCTION AZ
85120-5075
US

IV. Provider business mailing address

360 S IRONWOOD DR
APACHE JUNCTION AZ
85120-5075
US

V. Phone/Fax

Practice location:
  • Phone: 480-982-1171
  • Fax: 480-982-9189
Mailing address:
  • Phone: 480-982-1171
  • Fax: 480-982-9189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number932
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: