1255643623 NPI number — AMERICAN FAMILY CHIROPRACTIC & REHAB OF AVONDALE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255643623 NPI number — AMERICAN FAMILY CHIROPRACTIC & REHAB OF AVONDALE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN FAMILY CHIROPRACTIC & REHAB OF AVONDALE 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:
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:
1255643623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1839 S ALMA SCHOOL RD
Provider Second Line Business Mailing Address:
STE 354
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85210-3023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-726-2287
Provider Business Mailing Address Fax Number:
480-821-9360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 N AVONDALE BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
AVONDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85323-6905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-726-2287
Provider Business Practice Location Address Fax Number:
480-821-9360
Provider Enumeration Date:
07/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BOCK
Authorized Official First Name:
JOSH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PARTNER
Authorized Official Telephone Number:
480-726-2287

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com