Healthcare Provider Details

I. General information

NPI: 1124245402
Provider Name (Legal Business Name): GILBERT FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 W ELLIOT RD 115
GILBERT AZ
85233-5301
US

IV. Provider business mailing address

725 W ELLIOT RD 115
GILBERT AZ
85233-5301
US

V. Phone/Fax

Practice location:
  • Phone: 480-545-0000
  • Fax: 480-545-7615
Mailing address:
  • Phone: 480-545-0000
  • Fax: 480-545-7615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number5378
License Number StateAZ

VIII. Authorized Official

Name: ALISA MARLO WASSERMAN
Title or Position: OWNER
Credential: D.C.
Phone: 480-545-0000