Provider Demographics
NPI:1043594187
Name:CHIROPRACTIC REHAB AND NEUROLOGY INC.
Entity Type:Organization
Organization Name:CHIROPRACTIC REHAB AND NEUROLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:MATIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC,DIBCN
Authorized Official - Phone:623-587-0277
Mailing Address - Street 1:2525 W CAREFREE HWY BLDG 1
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-6093
Mailing Address - Country:US
Mailing Address - Phone:623-587-0277
Mailing Address - Fax:623-587-0270
Practice Address - Street 1:2525 W CAREFREE HWY BLDG 1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-6093
Practice Address - Country:US
Practice Address - Phone:623-587-0277
Practice Address - Fax:623-587-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5518111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU62219Medicare UPIN