Provider Demographics
NPI:1275848483
Name:KWD, PLLC
Entity Type:Organization
Organization Name:KWD, PLLC
Other - Org Name:CORRECTIVE SPINE AND DISC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:WESTEN
Authorized Official - Last Name:DANA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-726-2250
Mailing Address - Street 1:600 S DOBSON RD
Mailing Address - Street 2:#E38
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5678
Mailing Address - Country:US
Mailing Address - Phone:480-726-2250
Mailing Address - Fax:480-855-6121
Practice Address - Street 1:600 S DOBSON RD
Practice Address - Street 2:#E38
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5678
Practice Address - Country:US
Practice Address - Phone:480-726-2250
Practice Address - Fax:480-855-6121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7978111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ133648Medicare PIN