Healthcare Provider Details

I. General information

NPI: 1194262766
Provider Name (Legal Business Name): TANNER CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33755 N. SCOTTSDALE RD #101
SCOTTSDALE AZ
85266-1567
US

IV. Provider business mailing address

33755 N. SCOTTSDALE RD #101
SCOTTSDALE AZ
85266-1567
US

V. Phone/Fax

Practice location:
  • Phone: 480-595-6100
  • Fax: 480-595-6102
Mailing address:
  • Phone: 480-595-6100
  • Fax: 480-595-6102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5739
License Number StateAZ

VIII. Authorized Official

Name: MR. GLEN J TANNER
Title or Position: OWNER
Credential: DC
Phone: 480-595-6100