Provider Demographics
NPI:1992855910
Name:DEVER, DOUGLAS GORDON (DC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:GORDON
Last Name:DEVER
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 1:2855 E BROWN RD STE 7
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-4214
Mailing Address - Country:US
Mailing Address - Phone:480-924-1987
Mailing Address - Fax:
Practice Address - Street 1:2855 E BROWN RD STE 7
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-4214
Practice Address - Country:US
Practice Address - Phone:480-924-1987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDC3998111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT41550Medicare UPIN