Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 5571 | AZ |
NPI | 1033271432 |
---|---|
Provider Name | Dr. Jon M Tanner |
First Address | Scottsdale, AZ 85255-6122 |
Second Address | Scottsdale, AZ 85262-5240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AZ0244760 | BLUE CROSS BLUE SHIELD (01) | AZ |