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General NPI Number Information
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NPI Number | 1598324733
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Entity Type | Organization
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Legal Business Name | GILBERT COMPLETE MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 06/11/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 201 W GUADALUPE RD STE 102
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City | GILBERT
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State | AZ
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Zip | 85233-3318
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Country | US
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Telephone | 480-297-3703
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Fax |
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Provider Business Mailing Address
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Address Line | 201 W GUADALUPE RD STE 102
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City | GILBERT
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State | AZ
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Zip | 85233-3318
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | JODI LESTER
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Credential |
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Telephone | 480-219-6631
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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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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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