Healthcare Provider Details

I. General information

NPI: 1013123264
Provider Name (Legal Business Name): TARE C GURIRA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1094 S GILBERT RD BLDG B-2
GILBERT AZ
85296-3445
US

IV. Provider business mailing address

2320 W MEGAN ST
CHANDLER AZ
85224-3485
US

V. Phone/Fax

Practice location:
  • Phone: 480-926-0888
  • Fax: 480-926-0886
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4078
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number7229
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: