Healthcare Provider Details

I. General information

NPI: 1821268632
Provider Name (Legal Business Name): BACKFIT GILBERT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 S VAL VISTA DR STE 105
GILBERT AZ
85296-3139
US

IV. Provider business mailing address

754 S VAL VISTA DR STE 105
GILBERT AZ
85296-3139
US

V. Phone/Fax

Practice location:
  • Phone: 480-497-2900
  • Fax: 480-497-2906
Mailing address:
  • Phone: 480-497-2900
  • Fax: 480-497-2906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number7708
License Number StateAZ

VIII. Authorized Official

Name: DR. GREG VOGEL
Title or Position: MEMBER MANAGER
Credential: D.C.
Phone: 480-497-2900