Provider Demographics
NPI:1164951208
Name:AZ LIFESTYLE CHIROPRACTIC CENTER, PC
Entity Type:Organization
Organization Name:AZ LIFESTYLE CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-723-1494
Mailing Address - Street 1:14155 N 83RD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5640
Mailing Address - Country:US
Mailing Address - Phone:623-878-0475
Mailing Address - Fax:623-878-0640
Practice Address - Street 1:14155 N 83RD AVE STE 102
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5640
Practice Address - Country:US
Practice Address - Phone:623-878-0475
Practice Address - Fax:623-878-0640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDC5016111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty