Healthcare Provider Details

I. General information

NPI: 1609070028
Provider Name (Legal Business Name): OKANE SAN, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 E PALO VERDE ST STE 11
GILBERT AZ
85296-1021
US

IV. Provider business mailing address

PO BOX 1686
GILBERT AZ
85299-1686
US

V. Phone/Fax

Practice location:
  • Phone: 480-686-9942
  • Fax: 480-686-9943
Mailing address:
  • Phone: 480-686-9942
  • Fax: 480-686-9943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2034
License Number StateAZ

VIII. Authorized Official

Name: DR. DAVID J. RICKS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 480-545-0062