1881087567 NPI number — CHIROTRENDZ LLC

Table of content: (NPI 1881087567)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881087567 NPI number — CHIROTRENDZ LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIROTRENDZ LLC
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:
CHIROTRENDZ FAMILY CHIROPRACTIC AND WELLNESS CENTER
Provider Other Organization Name Type Code:
3
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:
1881087567
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18610 E RITTENHOUSE RD STE A101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUEEN CREEK
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85142-4503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-999-4700
Provider Business Mailing Address Fax Number:
480-999-4700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18610 E RITTENHOUSE RD STE A101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUEEN CREEK
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85142-4503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-999-4700
Provider Business Practice Location Address Fax Number:
480-999-4700
Provider Enumeration Date:
03/05/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WOLFLEY
Authorized Official First Name:
KOLBY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/CHIROPRACTOR
Authorized Official Telephone Number:
480-999-4700

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  8350 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 8456 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NN1001X , with the licence number: 8350 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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