Provider Demographics
NPI:1922200732
Name:CHANDLER, DOUGLAS B (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:B
Last Name:CHANDLER
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 1:9870 S 46TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5533
Mailing Address - Country:US
Mailing Address - Phone:480-628-2426
Mailing Address - Fax:
Practice Address - Street 1:809 GAIL GARDNER WAY STE B
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1801
Practice Address - Country:US
Practice Address - Phone:928-778-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0938370OtherBCBS
AZ76213Medicare ID - Type Unspecified