Organization
GONSTEAD PHYSICAL MEDICINE PC
Active
Other names
Gonstead Spine Institute PC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSE LARA (CHIROPRACTOR)
(602) 973-1630
Entity
Organization
Contact information
Practice address
2735 W UNION HILLS DR, SUITE 102, PHOENIX, AZ 85027-5033
(602) 973-1630
(602) 973-1667
Mailing address
2735 W UNION HILLS DR, SUITE 102, PHOENIX, AZ 85027-5033
(602) 973-1630
(602) 973-1667
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5303
AZ
Other
Enumeration date
04/17/2007
Last updated
06/17/2019
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