Healthcare Provider Details

I. General information

NPI: 1760692255
Provider Name (Legal Business Name): BRUCE K RESNICK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 E BASELINE ROAD SUITE 101
GILBERT AZ
85234-2966
US

IV. Provider business mailing address

4915 E BASELINE ROAD SUITE 101
GILBERT AZ
85234-2966
US

V. Phone/Fax

Practice location:
  • Phone: 480-926-7100
  • Fax: 480-926-7101
Mailing address:
  • Phone: 480-926-7100
  • Fax: 480-926-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number5756
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: