Healthcare Provider Details

I. General information

NPI: 1679031942
Provider Name (Legal Business Name): GERALD JOHN NEUFANG III D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 S 48TH ST STE 108
PHOENIX AZ
85044-1787
US

IV. Provider business mailing address

11011 S 48TH ST STE 108
PHOENIX AZ
85044-1787
US

V. Phone/Fax

Practice location:
  • Phone: 480-893-2412
  • Fax: 480-893-2412
Mailing address:
  • Phone: 480-893-2412
  • Fax: 480-893-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8790
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: