Provider Demographics
NPI:1346596780
Name:MAPLE LEAF CHIROPRACTIC
Entity Type:Organization
Organization Name:MAPLE LEAF CHIROPRACTIC
Other - Org Name:HEALTH SOURCE OF TEMPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-831-2870
Mailing Address - Street 1:7420 S RURAL RD STE B6
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-4655
Mailing Address - Country:US
Mailing Address - Phone:480-831-2870
Mailing Address - Fax:480-831-2872
Practice Address - Street 1:7420 S RURAL RD STE B6
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-4655
Practice Address - Country:US
Practice Address - Phone:480-831-2870
Practice Address - Fax:480-831-2872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ29145Medicare UPIN