=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437499514
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NATURAL DOCTOR J, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2013
-----------------------------------------------------
Last Update Date | 06/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8314 E HIGHLAND AVE
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85251-1733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-221-3225
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8314 E HIGHLAND AVE
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85251-1733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-221-3225
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JORDAN HOFFMAN
-----------------------------------------------------
Credential | NMD
-----------------------------------------------------
Telephone | 480-221-3225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | 12-1329
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------