Healthcare Provider Details

I. General information

NPI: 1417950999
Provider Name (Legal Business Name): HOWARD DARYL FERN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W GUADALUPE RD STE 311
GILBERT AZ
85233-3319
US

IV. Provider business mailing address

201 W GUADALUPE RD STE 311
GILBERT AZ
85233-3319
US

V. Phone/Fax

Practice location:
  • Phone: 480-649-5868
  • Fax: 480-649-5870
Mailing address:
  • Phone: 480-649-5868
  • Fax: 480-649-5870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5306
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: