Provider Demographics
NPI:1356673800
Name:QUEEN CREEK BACK CARE, LLC
Entity Type:Organization
Organization Name:QUEEN CREEK BACK CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-241-1611
Mailing Address - Street 1:20231 E OCOTILLO RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-7639
Mailing Address - Country:US
Mailing Address - Phone:480-677-3900
Mailing Address - Fax:480-677-8310
Practice Address - Street 1:20231 E OCOTILLO RD
Practice Address - Street 2:SUITE 1
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-7639
Practice Address - Country:US
Practice Address - Phone:480-677-3900
Practice Address - Fax:480-677-8310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5944111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty