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General NPI Number Information
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NPI Number | 1699480210
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Entity Type | Organization
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Legal Business Name | MARANA CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 01/18/2023
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Last Update Date | 01/18/2023
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Provider Practice Location Address
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Address Line | 13808 N SANDARIO RD STE 110
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City | MARANA
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State | AZ
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Zip | 85653-9177
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Country | US
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Telephone | 520-261-9153
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Fax |
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Provider Business Mailing Address
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Address Line | 12135 N CAMDEN DR
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City | MARANA
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State | AZ
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Zip | 85653-0226
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Country | US
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Telephone | 520-495-8159
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. NATHAN JACOB GOMEZ
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Credential | D.C
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Telephone | 520-549-8159
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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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