Provider Demographics
NPI:1164775425
Name:INTEGRATED HEALTH CENTERS OF ARIZONA PLC
Entity Type:Organization
Organization Name:INTEGRATED HEALTH CENTERS OF ARIZONA PLC
Other - Org Name:AHNEN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:RAYGOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-755-7777
Mailing Address - Street 1:2058 S DOBSON RD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6454
Mailing Address - Country:US
Mailing Address - Phone:480-755-7777
Mailing Address - Fax:480-752-3281
Practice Address - Street 1:2058 S DOBSON RD
Practice Address - Street 2:SUITE 16
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6454
Practice Address - Country:US
Practice Address - Phone:480-755-7777
Practice Address - Fax:480-752-3281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5682111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU64670Medicare UPIN
AZZDC5682Medicare PIN