Provider Demographics
NPI:1316184716
Name:BHAKTA, TANOJ C (DC)
Entity Type:Individual
Prefix:DR
First Name:TANOJ
Middle Name:C
Last Name:BHAKTA
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 1:3317 S HIGLEY RD
Mailing Address - Street 2:114-320
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-5436
Mailing Address - Country:US
Mailing Address - Phone:480-463-4325
Mailing Address - Fax:413-294-2931
Practice Address - Street 1:2509 S POWER RD
Practice Address - Street 2:115
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-6695
Practice Address - Country:US
Practice Address - Phone:480-985-7070
Practice Address - Fax:480-641-7408
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7559111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6414780001Medicare NSC
AZ103931Medicare PIN
AZV05577Medicare UPIN