Provider Demographics
NPI:1043474646
Name:SUPERSTITION CHIROPRACTIC CENTER PLLC
Entity Type:Organization
Organization Name:SUPERSTITION CHIROPRACTIC CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-963-2772
Mailing Address - Street 1:1880 S ALMA SCHOOL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-7074
Mailing Address - Country:US
Mailing Address - Phone:480-963-2772
Mailing Address - Fax:480-248-6679
Practice Address - Street 1:5341 S SUPERSTITION MOUNTAIN DR STE D101
Practice Address - Street 2:
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85218-2069
Practice Address - Country:US
Practice Address - Phone:480-963-2772
Practice Address - Fax:480-248-6679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-12
Last Update Date:2008-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty