Provider Demographics
NPI:1376669606
Name:BADGER WEST CORPORATION
Entity Type:Organization
Organization Name:BADGER WEST CORPORATION
Other - Org Name:ADVANCED BACK PAIN & INJURY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MCFARLANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-494-3037
Mailing Address - Street 1:11030 N TATUM BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6073
Mailing Address - Country:US
Mailing Address - Phone:602-494-3037
Mailing Address - Fax:602-996-5274
Practice Address - Street 1:11030 N TATUM BLVD STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6073
Practice Address - Country:US
Practice Address - Phone:602-494-3037
Practice Address - Fax:602-996-5274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0249180OtherBCBS OF ARIZONA
AZAZ0249180OtherBCBS OF ARIZONA