Provider Demographics
NPI:1225216336
Name:PROGRESSIVE CHIROPRACTIC CENTER, PC
Entity Type:Organization
Organization Name:PROGRESSIVE CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-636-4266
Mailing Address - Street 1:1549 N BURK ST
Mailing Address - Street 2:STE 100
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2483
Mailing Address - Country:US
Mailing Address - Phone:480-497-2642
Mailing Address - Fax:480-497-1863
Practice Address - Street 1:1549 N BURK ST
Practice Address - Street 2:STE 100
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2483
Practice Address - Country:US
Practice Address - Phone:480-497-2642
Practice Address - Fax:480-497-1863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4490111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ60997Medicare PIN