Provider Demographics
NPI:1275672412
Name:LANDAU, GREGORY A (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:LANDAU
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 1:10304 N HAYDEN RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-1217
Mailing Address - Country:US
Mailing Address - Phone:480-948-6020
Mailing Address - Fax:480-948-0250
Practice Address - Street 1:10304 N HAYDEN RD
Practice Address - Street 2:SUITE 5
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-1217
Practice Address - Country:US
Practice Address - Phone:480-948-6020
Practice Address - Fax:480-948-0250
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1055111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor