Provider Demographics
NPI:1861731176
Name:NEEL, JOHN DAVID (AT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:NEEL
Suffix:
Gender:M
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 E EVANS DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2827
Mailing Address - Country:US
Mailing Address - Phone:602-996-0455
Mailing Address - Fax:
Practice Address - Street 1:9332 N 95TH WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5536
Practice Address - Country:US
Practice Address - Phone:480-948-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0083172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0083OtherARIZONA BOARD OF ATHLETIC TRAINING