Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 3510 | AZ |
NPI | 1033273396 |
---|---|
Provider Name | Dr. Douglas Scott Tanner |
First Address | Phoenix, AZ 85069-8102 |
Second Address | Phoenix, AZ 85051-6687 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 08/07/2007 |