Provider Demographics
NPI:1326160052
Name:VALLEY CHIROPRACTIC AND REHAB CLINIC PLLC
Entity Type:Organization
Organization Name:VALLEY CHIROPRACTIC AND REHAB CLINIC PLLC
Other - Org Name:VALLEY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-327-9898
Mailing Address - Street 1:626 E MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-2808
Mailing Address - Country:US
Mailing Address - Phone:623-327-9898
Mailing Address - Fax:623-327-9799
Practice Address - Street 1:626 E MONROE AVE
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-2808
Practice Address - Country:US
Practice Address - Phone:623-327-9898
Practice Address - Fax:623-327-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7555261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
V04544Medicare UPIN
Z114020Medicare PIN