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General NPI Number Information
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NPI Number | 1114462777
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Entity Type | Organization
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Legal Business Name | DR JON TANNER CHIROPRACTIC AND ACUPUNCTURE LLC
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Dates
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Enumeration Date | 01/05/2017
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Last Update Date | 03/21/2017
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Provider Practice Location Address
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Address Line | 33755 N SCOTTSDALE RD #101
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City | SCOTTSDALE
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State | AZ
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Zip | 85266-1567
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Country | US
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Telephone | 480-595-6100
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Fax | 480-595-6102
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Provider Business Mailing Address
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Address Line | 33755 N SCOTTSDALE RD #101
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City | SCOTTSDALE
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State | AZ
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Zip | 85266-1567
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Country | US
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Telephone | 480-595-6100
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Fax | 480-595-6102
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Authorized Official
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Title or Position | OWNER
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Name | MR. JON M TANNER
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Credential | DC
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Telephone | 480-595-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 304
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5571
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License Number State | AZ
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