1245462738 NPI number — ARIZONA CHIROPRACTIC CLINIC, PLLC

Table of content: (NPI 1245462738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245462738 NPI number — ARIZONA CHIROPRACTIC CLINIC, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARIZONA CHIROPRACTIC CLINIC, 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:
1245462738
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
509 W WETMORE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85705-1521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-219-5700
Provider Business Mailing Address Fax Number:
520-219-5704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
509 W WETMORE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85705-1521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-219-5700
Provider Business Practice Location Address Fax Number:
520-219-5704
Provider Enumeration Date:
08/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
VALENZUELA
Authorized Official First Name:
FRANCISCO
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER/DOCTOR
Authorized Official Telephone Number:
520-219-5700

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  7443 , 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: 102582 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: P00667081 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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