Healthcare Provider Details

I. General information

NPI: 1275631335
Provider Name (Legal Business Name): BRIAN JAMES ARCHAMBAULT NMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10320 W MCDOWELL RD M-1342
AVONDALE AZ
85323-4863
US

IV. Provider business mailing address

10320 W MCDOWELL RD M-1342
AVONDALE AZ
85323-4863
US

V. Phone/Fax

Practice location:
  • Phone: 623-643-9598
  • Fax: 623-478-0960
Mailing address:
  • Phone: 623-643-9598
  • Fax: 623-478-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number03-777
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: