1841430667 NPI number — SOUTHWEST CHIROPRACTIC GROUP PLLC

Table of content: (NPI 1841430667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841430667 NPI number — SOUTHWEST CHIROPRACTIC GROUP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST CHIROPRACTIC GROUP PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841430667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20701 N SCOTTSDALE RD
Provider Second Line Business Mailing Address:
#107-200
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85255-6413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-992-4770
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4845 E THUNDERBIRD RD
Provider Second Line Business Practice Location Address:
#4
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85254-3556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-992-4770
Provider Business Practice Location Address Fax Number:
602-992-4053
Provider Enumeration Date:
03/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MITCHELL
Authorized Official First Name:
GRAEME
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
602-992-4770

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  7083 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1013050491 . This is a "PHYSICIAN NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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