Healthcare Provider Details

I. General information

NPI: 1518966332
Provider Name (Legal Business Name): DONALD H. DEARTH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2052 E SOUTHERN AVE
TEMPE AZ
85282-7515
US

IV. Provider business mailing address

2052 E SOUTHERN AVE
TEMPE AZ
85282-7515
US

V. Phone/Fax

Practice location:
  • Phone: 480-756-6044
  • Fax: 480-756-1107
Mailing address:
  • Phone: 480-756-6044
  • Fax: 480-756-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4484
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: