Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 7327 | AZ |
N | 111NR0400X | Rehabilitation Chiropractor | 4012 | AZ |
NPI | 1013985415 |
---|---|
Provider Name | Dr. Brian Wright |
First Address | Gilbert, AZ 85296-4202 |
Second Address | Gilbert, AZ 85296-4202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 20/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4012 | PHYSIOTHERAPY CERTIFICATE (01) | AZ |
7327 | AZ BOARD NUMBER (01) | AZ |