Healthcare Provider Details

I. General information

NPI: 1508239443
Provider Name (Legal Business Name): JOHN GANGEMI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2015
Last Update Date: 10/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7005 E CAVE CREEK RD SUITE 103
CAVE CREEK AZ
85331-8631
US

IV. Provider business mailing address

34522 N SCOTTSDALE RD SUITE 120-131
SCOTTSDALE AZ
85266-1224
US

V. Phone/Fax

Practice location:
  • Phone: 480-575-2727
  • Fax:
Mailing address:
  • Phone: 480-575-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number8191
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: