1700057270 NPI number — CHIROPRACTIC PHYSICIANS OF SCOTTSDALE, A WELLNESS CENTER, PLLC

Table of content: BARRY LEWIS JR. LLMSW (NPI 1609415785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700057270 NPI number — CHIROPRACTIC PHYSICIANS OF SCOTTSDALE, A WELLNESS CENTER, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIROPRACTIC PHYSICIANS OF SCOTTSDALE, A WELLNESS CENTER, 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:
THE SOAR CLINIC
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:
1700057270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8070 E. MORGAN TRAIL
Provider Second Line Business Mailing Address:
#125
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85258-1228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-998-7627
Provider Business Mailing Address Fax Number:
480-998-2309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8070 E MORGAN TRL
Provider Second Line Business Practice Location Address:
#125
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85258-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-998-7627
Provider Business Practice Location Address Fax Number:
480-998-2309
Provider Enumeration Date:
03/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GUILFORD
Authorized Official First Name:
EVELYN
Authorized Official Middle Name:
THERESA
Authorized Official Title or Position:
CHIROPRACTOR/OWNER
Authorized Official Telephone Number:
480-998-7627

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  7538 , 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)





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