Healthcare Provider Details

I. General information

NPI: 1164726717
Provider Name (Legal Business Name): NATHAN EDWARD GRINDER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 E OCOTILLO RD STE 4
CHANDLER AZ
85249-6040
US

IV. Provider business mailing address

4337 E AMBER LN
GILBERT AZ
85296-1585
US

V. Phone/Fax

Practice location:
  • Phone: 480-781-2964
  • Fax: 480-809-4988
Mailing address:
  • Phone: 602-430-4486
  • Fax: 480-809-4988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8174
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number8174
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number8174
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: