Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 8484 | AZ |
N | 111NI0013X | Independent Medical Examiner | 8484 | AZ |
N | 111NN0400X | Neurology | 8484 | AZ |
N | 111NN1001X | Nutrition | 8484 | AZ |
N | 111NP0017X | Pediatric Chiropractor | 8484 | AZ |
N | 111NR0200X | Radiology | 8484 | AZ |
N | 213ER0200X | Radiology | 8484 | AZ |
N | 111NS0005X | Chiropractic Sports Physician | 8484 | AZ |
N | 111NT0100X | Thermography | 8484 | AZ |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 8484 | AZ |
NPI | 1245605583 |
---|---|
Provider Name | Dr. Gaylen N. Bartlett III |
First Address | Peoria, AZ 85381-4902 |
Second Address | Peoria, AZ 85381-4902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2015 |
Last Update Date | 12/12/2015 |