Provider Demographics
NPI:1750445805
Name:HUSTON, GUY GORDON (DC)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:GORDON
Last Name:HUSTON
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 1:18001 N 79TH AVE
Mailing Address - Street 2:SUITE B 20
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8388
Mailing Address - Country:US
Mailing Address - Phone:623-776-9300
Mailing Address - Fax:623-776-9210
Practice Address - Street 1:18001 N 79TH AVE
Practice Address - Street 2:SUITE B 20
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8388
Practice Address - Country:US
Practice Address - Phone:623-776-9300
Practice Address - Fax:623-776-9210
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU88258Medicare UPIN
AZZ105452Medicare ID - Type Unspecified