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General NPI Number Information
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NPI Number | 1386001949
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Entity Type | Organization
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Legal Business Name | GATEWAY CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 05/12/2017
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Provider Practice Location Address
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Address Line | 10320 W MCDOWELL RD A-1004
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City | AVONDALE
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State | AZ
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Zip | 85392-4863
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Country | US
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Telephone | 602-566-7676
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Fax | 602-566-7677
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Provider Business Mailing Address
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Address Line | 10320 W MCDOWELL RD A-1004
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City | AVONDALE
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State | AZ
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Zip | 85392-4863
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Country | US
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Telephone | 602-566-7676
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Fax | 602-566-7677
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Authorized Official
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Title or Position | CEO
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Name | MR. CORY SIMONS
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Credential | D.C.
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Telephone | 602-566-7676
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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 |
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License Number State |
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