Provider Demographics
NPI:1255652533
Name:DESERT SHADOWS CHIROPRACTIC & WELLNESS
Entity Type:Organization
Organization Name:DESERT SHADOWS CHIROPRACTIC & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:CARLTON
Authorized Official - Last Name:CAMPO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-595-0015
Mailing Address - Street 1:4010 E BELL RD
Mailing Address - Street 2:SUITE #103
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2229
Mailing Address - Country:US
Mailing Address - Phone:602-595-0015
Mailing Address - Fax:602-595-0091
Practice Address - Street 1:4010 E BELL RD
Practice Address - Street 2:SUITE #103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2229
Practice Address - Country:US
Practice Address - Phone:602-595-0015
Practice Address - Fax:602-595-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty