Provider Demographics
NPI:1689861551
Name:BATES, BRENNAN G (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENNAN
Middle Name:G
Last Name:BATES
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 1:2133 E WARNER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3492
Mailing Address - Country:US
Mailing Address - Phone:480-820-6695
Mailing Address - Fax:480-820-6696
Practice Address - Street 1:2133 E WARNER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3492
Practice Address - Country:US
Practice Address - Phone:480-820-6695
Practice Address - Fax:480-820-6696
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7861111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor