Provider Demographics
NPI:1134670870
Name:GARY HENDRIX PLLC
Entity Type:Organization
Organization Name:GARY HENDRIX PLLC
Other - Org Name:COOLIDGE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRIX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-723-3441
Mailing Address - Street 1:803 N ARIZONA BLVD
Mailing Address - Street 2:
Mailing Address - City:COOLIDGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85128-3921
Mailing Address - Country:US
Mailing Address - Phone:520-723-3441
Mailing Address - Fax:
Practice Address - Street 1:803 N ARIZONA BLVD
Practice Address - Street 2:
Practice Address - City:COOLIDGE
Practice Address - State:AZ
Practice Address - Zip Code:85128-3921
Practice Address - Country:US
Practice Address - Phone:520-723-3441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZDC4768Medicare UPIN