Provider Demographics
NPI:1447560933
Name:WARRIOR RESTORATION
Entity Type:Organization
Organization Name:WARRIOR RESTORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-334-6646
Mailing Address - Street 1:4710 N 44TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3834
Mailing Address - Country:US
Mailing Address - Phone:602-840-3430
Mailing Address - Fax:602-522-1800
Practice Address - Street 1:4710 N 44TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3834
Practice Address - Country:US
Practice Address - Phone:602-840-3430
Practice Address - Fax:602-522-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty