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NPI Code Detail

MEDICARE: BRENDAN WAYNE POTTER D.C.

MEDICARE:   BRENDAN WAYNE POTTER  D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor8201AZ

General Provider Information

NPI Number : 1043505563
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDAN WAYNE POTTER D.C.
Provider Business Mailing Address
First Line : 1925 E BROWN RD
Second Line : STE A1
City : MESA
State : AZ
Zip : 85203-5135
Country : US
Telephone Number : 480-322-0934
Fax Number :
Provider Business Practice Location Address
First Line : 2292 W MAGEE RD
Second Line :
City : TUCSON
State : AZ
Zip : 85742-4301
Country : US
Telephone Number : 520-797-2922
Fax Number : 520-742-0732
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2011
Last Update Date : 08/11/2016

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Directions to “ BRENDAN WAYNE POTTER D.C.” Practice Location

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