Provider Demographics
NPI:1225217110
Name:COMBS SURPRISE CROSSING, LLC
Entity Type:Organization
Organization Name:COMBS SURPRISE CROSSING, LLC
Other - Org Name:SURPRISE CROSSING CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:E
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-584-7756
Mailing Address - Street 1:13794 W WADDELL RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-8499
Mailing Address - Country:US
Mailing Address - Phone:623-584-7756
Mailing Address - Fax:
Practice Address - Street 1:13794 W WADDELL RD
Practice Address - Street 2:SUITE 205
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-8499
Practice Address - Country:US
Practice Address - Phone:623-584-7756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4793111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty