Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 2056 | AZ |
NPI | 1699852434 |
---|---|
Provider Name | Dr. Gary Allen Love |
First Address | Tucson, AZ 85716-1518 |
Second Address | Tucson, AZ 85716-1518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
41884 | (02) | AZ |