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NPI Code Detail

MEDICARE: EAST THOMAS CHIROPRACTIC CENTER PC

MEDICARE: EAST THOMAS CHIROPRACTIC CENTER PC
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
1111N00000XChiropractor1048AZ

General Provider Information

NPI Number : 1225021579
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST THOMAS CHIROPRACTIC CENTER PC
Provider Business Mailing Address
First Line : 1802 E THOMAS RD
Second Line : SUITE 16
City : PHOENIX
State : AZ
Zip : 85016-8134
Country : US
Telephone Number : 602-265-6893
Fax Number : 602-631-9362
Provider Business Practice Location Address
First Line : 1802 E THOMAS RD
Second Line : SUITE 16
City : PHOENIX
State : AZ
Zip : 85016-8134
Country : US
Telephone Number : 602-265-6893
Fax Number : 602-631-9362
Authorized Official
Title or Position : CEO
Name : GARY WAYNE DIEKMANN
Credential : DC
Telephone Number : 602-265-6893
Provider Enumeration Date : 08/23/2005
Last Update Date : 08/22/2020

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Directions to “EAST THOMAS CHIROPRACTIC CENTER PC ” Practice Location

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