Provider Demographics
NPI:1164590006
Name:WARKENTIN, DAVID A (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:WARKENTIN
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 1:4824 E BASELINE RD STE 140
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4680
Mailing Address - Country:US
Mailing Address - Phone:480-969-4040
Mailing Address - Fax:480-830-9202
Practice Address - Street 1:4824 E BASELINE RD
Practice Address - Street 2:SUITE #140
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4676
Practice Address - Country:US
Practice Address - Phone:480-969-4040
Practice Address - Fax:480-830-8202
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7042111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0750140OtherBLUE CROSS BLUE SHIELD
Z69153Medicare ID - Type Unspecified
AZAZ0750140OtherBLUE CROSS BLUE SHIELD