Provider Demographics
NPI:1275144107
Name:REFORM CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:REFORM CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-597-7838
Mailing Address - Street 1:1810 S POWER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4325
Mailing Address - Country:US
Mailing Address - Phone:480-597-7838
Mailing Address - Fax:480-393-3276
Practice Address - Street 1:1810 S POWER RD STE 103
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4325
Practice Address - Country:US
Practice Address - Phone:480-597-7838
Practice Address - Fax:480-393-3276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty