Provider Demographics
NPI:1033566906
Name:WEST VALLEY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:WEST VALLEY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-547-0922
Mailing Address - Street 1:4900 N LITCHFIELD ROAD BYP
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-5061
Mailing Address - Country:US
Mailing Address - Phone:623-547-0922
Mailing Address - Fax:623-547-0922
Practice Address - Street 1:4900 N LITCHFIELD ROAD BYP
Practice Address - Street 2:SUITE C-2
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-5061
Practice Address - Country:US
Practice Address - Phone:623-547-0922
Practice Address - Fax:623-547-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8542261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS102827Medicare PIN