Provider Demographics
NPI:1356689772
Name:ARIZONA PROGRESSIVE MEDICAL CENTERS
Entity Type:Organization
Organization Name:ARIZONA PROGRESSIVE MEDICAL CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVAC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-704-8818
Mailing Address - Street 1:15215 S 48TH ST
Mailing Address - Street 2:SUITE 156
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-9142
Mailing Address - Country:US
Mailing Address - Phone:480-704-8818
Mailing Address - Fax:480-704-8819
Practice Address - Street 1:15215 S 48TH ST
Practice Address - Street 2:BLDG 5 SUITE 156
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-9142
Practice Address - Country:US
Practice Address - Phone:480-704-8818
Practice Address - Fax:480-704-8819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGMedicare UPIN