Healthcare Provider Details

I. General information

NPI: 1669477535
Provider Name (Legal Business Name): JAY DOUGLAS MCFARLANE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 12/10/2022
Certification Date: 12/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11030 N TATUM BLVD STE 102
PHOENIX AZ
85028-6073
US

IV. Provider business mailing address

11030 N TATUM BLVD SUITE 102
PHOENIX AZ
85028-6073
US

V. Phone/Fax

Practice location:
  • Phone: 602-494-3037
  • Fax: 602-996-5274
Mailing address:
  • Phone: 602-494-3037
  • Fax: 602-996-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4890
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: