Provider Demographics
NPI:1245605583
Name:BARTLETT, GAYLEN N III (DC)
Entity Type:Individual
Prefix:DR
First Name:GAYLEN
Middle Name:N
Last Name:BARTLETT
Suffix:III
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 1:7966 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4902
Mailing Address - Country:US
Mailing Address - Phone:623-225-5560
Mailing Address - Fax:
Practice Address - Street 1:7966 W THUNDERBIRD RD
Practice Address - Street 2:SUITE # 102
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4902
Practice Address - Country:US
Practice Address - Phone:623-225-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-12
Last Update Date:2015-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8484111N00000X, 111NI0013X, 111NN0400X, 111NN1001X, 111NP0017X, 111NR0200X, 111NS0005X, 111NT0100X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111NN0400XChiropractic ProvidersChiropractorNeurology
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NT0100XChiropractic ProvidersChiropractorThermography
No111NX0800XChiropractic ProvidersChiropractorOrthopedic