Healthcare Provider Details

I. General information

NPI: 1962583088
Provider Name (Legal Business Name): JURGEN OLTJENBRUNS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7208 E CAVE CREEK RD SUITE F
CAREFREE AZ
85377
US

IV. Provider business mailing address

P.O. BOX 232
CAVE CREEK AZ
85327-0232
US

V. Phone/Fax

Practice location:
  • Phone: 480-488-1282
  • Fax: 480-488-9040
Mailing address:
  • Phone: 480-488-1282
  • Fax: 480-480-9040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5283
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: