Basic Information
| Provider Information | |||||||||
| NPI: | 1033367230 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 60003 DB HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2954 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850622954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026745515 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10046 NORTH METRO PARKWAY WEST | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850511411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026745515 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2008 | ||||||||
| LastUpdateDate: | 09/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | BRUNKHORST | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | EDWARD | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/OPERATOR | ||||||||
| AuthorizedOfficialTelephone: | 6026745515 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 7850 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.