Provider Demographics
NPI:1548286537
Name:BUSTAMANTE, NATALIE ANNE (DC)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANNE
Last Name:BUSTAMANTE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2036 E ASPEN
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282
Mailing Address - Country:US
Mailing Address - Phone:480-603-6443
Mailing Address - Fax:
Practice Address - Street 1:5950 S COOPER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-2221
Practice Address - Country:US
Practice Address - Phone:480-883-8801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7423111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V05578Medicare UPIN
AZZ103930Medicare ID - Type Unspecified