Provider Demographics
NPI:1114016557
Name:SCOTTSDALE CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:SCOTTSDALE CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:LEIBMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-949-1630
Mailing Address - Street 1:2765 N. SCOTTSDALE ROAD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257
Mailing Address - Country:US
Mailing Address - Phone:480-990-1818
Mailing Address - Fax:480-947-5797
Practice Address - Street 1:2765 N. SCOTTSDALE ROAD
Practice Address - Street 2:SUITE 108
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257
Practice Address - Country:US
Practice Address - Phone:480-990-1818
Practice Address - Fax:480-947-5797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ4757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZDC4757Medicare ID - Type Unspecified
AZU45921Medicare UPIN