Provider Demographics
NPI:1396936829
Name:GARRY J. KIRSTEN D.C.P.C.
Entity type:Organization
Organization Name:GARRY J. KIRSTEN D.C.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIRSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-361-3986
Mailing Address - Street 1:PO BOX 1044
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85372-1044
Mailing Address - Country:US
Mailing Address - Phone:602-361-3986
Mailing Address - Fax:
Practice Address - Street 1:4340 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85035-4225
Practice Address - Country:US
Practice Address - Phone:602-361-3986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty