Provider Demographics
NPI:1013033679
Name:POWER CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:POWER CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:GODARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-844-7900
Mailing Address - Street 1:2812 N NORWALK
Mailing Address - Street 2:SUITE 122
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1148
Mailing Address - Country:US
Mailing Address - Phone:480-844-7900
Mailing Address - Fax:480-699-4281
Practice Address - Street 1:1347 N GREENFIELD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4071
Practice Address - Country:US
Practice Address - Phone:480-844-7900
Practice Address - Fax:480-699-4281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5851111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ118809Medicare PIN