Provider Demographics
NPI:1467544759
Name:RELIEF SOURCE CHIROPRACTIC & WELLNESS CENTER PC
Entity Type:Organization
Organization Name:RELIEF SOURCE CHIROPRACTIC & WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:SONNY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPEDRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-345-1964
Mailing Address - Street 1:2815 S ALMA SCHOOL RD
Mailing Address - Street 2:STE 105
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-4032
Mailing Address - Country:US
Mailing Address - Phone:480-345-1964
Mailing Address - Fax:480-345-1973
Practice Address - Street 1:2815 S ALMA SCHOOL RD
Practice Address - Street 2:STE 105
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-4032
Practice Address - Country:US
Practice Address - Phone:480-345-1964
Practice Address - Fax:480-345-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U39179Medicare UPIN
AZDC4620AMedicare ID - Type Unspecified