Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 8174 | AZ |
N | 111NR0400X | Rehabilitation Chiropractor | 8174 | AZ |
N | 111NS0005X | Chiropractic Sports Physician | 8174 | AZ |
NPI | 1164726717 |
---|---|
Provider Name | Dr. Nathan Edward Grinder |
First Address | Gilbert, AZ 85296-1585 |
Second Address | Chandler, AZ 85249-6040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2010 |
Last Update Date | 10/05/2021 |