Provider Demographics
NPI:1073745782
Name:PHOENICIAN HEALTH GROUP LLC
Entity Type:Organization
Organization Name:PHOENICIAN HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAJERA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAJIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-955-9170
Mailing Address - Street 1:3244 E INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5012
Mailing Address - Country:US
Mailing Address - Phone:602-955-9170
Mailing Address - Fax:602-955-9176
Practice Address - Street 1:3244 E INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5012
Practice Address - Country:US
Practice Address - Phone:602-955-9170
Practice Address - Fax:602-955-9176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty