Provider Demographics
NPI:1346451408
Name:COMPLETE CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:COMPLETE CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:K
Authorized Official - Last Name:RESNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-926-7100
Mailing Address - Street 1:4915 E BASELINE ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2966
Mailing Address - Country:US
Mailing Address - Phone:480-926-7100
Mailing Address - Fax:480-926-7101
Practice Address - Street 1:4915 E BASELINE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2966
Practice Address - Country:US
Practice Address - Phone:480-926-7100
Practice Address - Fax:480-926-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5756111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0243120OtherBLUE CROSS
AZAX 1992OtherHEALTHNET
AZAZ0243120OtherBLUE CROSS