Provider Demographics
NPI:1710191754
Name:STANBRIDGE, GARY (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:STANBRIDGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 E BELL RD STE 140
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-2937
Mailing Address - Country:US
Mailing Address - Phone:602-788-3159
Mailing Address - Fax:602-788-0501
Practice Address - Street 1:2040 E BELL RD STE 140
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-2937
Practice Address - Country:US
Practice Address - Phone:602-788-3159
Practice Address - Fax:602-788-0501
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor