Healthcare Provider Details

I. General information

NPI: 1033271432
Provider Name (Legal Business Name): JON M TANNER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34597 N 60TH ST
SCOTTSDALE AZ
85262-5240
US

IV. Provider business mailing address

7397 E HANOVER WAY
SCOTTSDALE AZ
85255-6122
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 Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number5571
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: