Provider Demographics
NPI:1326298829
Name:JEFFREY A. TRINKA, P.C.
Entity Type:Organization
Organization Name:JEFFREY A. TRINKA, P.C.
Other - Org Name:GOODYEAR CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:G.M.
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:AA, CMBS,CA
Authorized Official - Phone:623-932-4060
Mailing Address - Street 1:11 W VAN BUREN ST
Mailing Address - Street 2:SUITE 28
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323
Mailing Address - Country:US
Mailing Address - Phone:623-932-4060
Mailing Address - Fax:623-932-4417
Practice Address - Street 1:11 W. VAN BUREN ST
Practice Address - Street 2:SUITE 28
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323
Practice Address - Country:US
Practice Address - Phone:623-932-4060
Practice Address - Fax:623-932-4417
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFREY A. TRINKA, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-22
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0932530OtherBLUE CROSS BLUE SHIELD
AZZ65151Medicare PIN
AZAZ0932530OtherBLUE CROSS BLUE SHIELD