Provider Demographics
NPI:1609070028
Name:OKANE SAN, P.C.
Entity Type:Organization
Organization Name:OKANE SAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-545-0062
Mailing Address - Street 1:PO BOX 1686
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85299-1686
Mailing Address - Country:US
Mailing Address - Phone:480-686-9942
Mailing Address - Fax:480-686-9943
Practice Address - Street 1:7 E PALO VERDE ST STE 11
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1021
Practice Address - Country:US
Practice Address - Phone:480-686-9942
Practice Address - Fax:480-686-9943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2034111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty