Provider Demographics
NPI:1215206206
Name:VAL VISTA CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:VAL VISTA CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:VAUN
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-830-2225
Mailing Address - Street 1:505 S VAL VISTA DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-3268
Mailing Address - Country:US
Mailing Address - Phone:480-830-2225
Mailing Address - Fax:480-361-6841
Practice Address - Street 1:505 S VAL VISTA DR
Practice Address - Street 2:SUITE 8
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-3268
Practice Address - Country:US
Practice Address - Phone:480-830-2225
Practice Address - Fax:480-361-6841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4087 AZ111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty