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General NPI Number Information
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NPI Number | 1154494896
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Entity Type | Organization
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Legal Business Name | MARTIN C GAGE PC
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 6382 W BELL RD
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City | GLENDALE
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State | AZ
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Zip | 85308
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Country | US
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Telephone | 623-878-4000
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Fax | 623-878-6195
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Provider Business Mailing Address
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Address Line | 6382 W BELL RD
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City | GLENDALE
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State | AZ
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Zip | 85308
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Country | US
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Telephone | 623-878-4000
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Fax | 623-878-6195
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Authorized Official
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Title or Position | CHIROPRACTOR OWNER
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Name | MARTIN GAGE
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Credential |
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Telephone | 623-878-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 08781
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License Number State | AZ
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