Provider Demographics
NPI:1417255209
Name:JLW CHIROPRACTIC
Entity Type:Organization
Organization Name:JLW CHIROPRACTIC
Other - Org Name:GONSTEAD FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:WARLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-815-1800
Mailing Address - Street 1:9420 W BELL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-1362
Mailing Address - Country:US
Mailing Address - Phone:623-815-1800
Mailing Address - Fax:623-815-0500
Practice Address - Street 1:9420 W BELL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-1362
Practice Address - Country:US
Practice Address - Phone:623-815-1800
Practice Address - Fax:623-815-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ144435OtherMEDICARE PTAN