Individual
DR. MARK ERIC VANDEVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
17224 N 43RD AVE, SUITE 105, GLENDALE, AZ 85308-4025
(602) 565-4402
(602) 843-3787
Mailing address
17224 N 43RD AVE, SUITE 105, GLENDALE, AZ 85308-4025
(602) 565-4402
(602) 843-3787
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5566
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5566
STATE LICENSE NUMBER
AZ
Enumeration date
03/22/2007
Last updated
07/08/2007
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