Provider Demographics
NPI:1518966332
Name:DEARTH, DONALD H (DC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:H
Last Name:DEARTH
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 1:2052 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7515
Mailing Address - Country:US
Mailing Address - Phone:480-756-6044
Mailing Address - Fax:480-756-1107
Practice Address - Street 1:2052 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7515
Practice Address - Country:US
Practice Address - Phone:480-756-6044
Practice Address - Fax:480-756-1107
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4484111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU16777Medicare UPIN
AZZ26324Medicare PIN