Provider Demographics
NPI:1003540519
Name:GHENTS, CODY MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:MICHAEL
Last Name:GHENTS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24700 N 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-4250
Mailing Address - Country:US
Mailing Address - Phone:623-259-3458
Mailing Address - Fax:
Practice Address - Street 1:24700 N 67TH AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-4250
Practice Address - Country:US
Practice Address - Phone:623-259-3458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9193111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor