Provider Demographics
NPI:1043514631
Name:SOMA CHIROPRACTIC LLC.
Entity Type:Organization
Organization Name:SOMA CHIROPRACTIC LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:THEODOROS
Authorized Official - Last Name:PASISIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-206-4438
Mailing Address - Street 1:5714 E ANGELA DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6409
Mailing Address - Country:US
Mailing Address - Phone:602-206-4438
Mailing Address - Fax:
Practice Address - Street 1:5714 E ANGELA DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6409
Practice Address - Country:US
Practice Address - Phone:602-206-4438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ105548Medicare PIN
AZAZ0945560Medicare UPIN