Provider Demographics
NPI:1457497893
Name:NETTLES, DONDEE JR (DC)
Entity Type:Individual
Prefix:DR
First Name:DONDEE
Middle Name:
Last Name:NETTLES
Suffix:JR
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 1:250 N LITCHFIELD RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1333
Mailing Address - Country:US
Mailing Address - Phone:623-298-2180
Mailing Address - Fax:623-298-2178
Practice Address - Street 1:250 N LITCHFIELD RD
Practice Address - Street 2:SUITE 205
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1333
Practice Address - Country:US
Practice Address - Phone:623-298-2180
Practice Address - Fax:623-298-2178
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8017111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation