Provider Demographics
NPI:1710526421
Name:GOMEZ, NATHAN JACOB (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:JACOB
Last Name:GOMEZ
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 1:8140 S HOUGHTON RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-4705
Mailing Address - Country:US
Mailing Address - Phone:520-574-3600
Mailing Address - Fax:
Practice Address - Street 1:8340 E VICKSBURG ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2948
Practice Address - Country:US
Practice Address - Phone:520-256-1254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor