Provider Demographics
NPI:1922384809
Name:NATHAN CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:NATHAN CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-400-2066
Mailing Address - Street 1:698 E WETMORE RD
Mailing Address - Street 2:STE 320
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-1751
Mailing Address - Country:US
Mailing Address - Phone:520-408-2225
Mailing Address - Fax:
Practice Address - Street 1:698 E WETMORE RD
Practice Address - Street 2:STE 320
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1751
Practice Address - Country:US
Practice Address - Phone:520-408-2225
Practice Address - Fax:520-293-1788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4727Medicare UPIN