Healthcare Provider Details

I. General information

NPI: 1679649693
Provider Name (Legal Business Name): JONATHAN JOSEPH DAVID D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 S ARIZONA AVE STE 12
CHANDLER AZ
85286-6509
US

IV. Provider business mailing address

1445 S ARIZONA AVE STE 12
CHANDLER AZ
85286-6509
US

V. Phone/Fax

Practice location:
  • Phone: 480-726-3305
  • Fax:
Mailing address:
  • Phone: 480-726-3305
  • Fax: 480-726-3508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7573
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number7573
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: