Provider Demographics
NPI:1467634626
Name:LIFEQUEST CHIROPRACTIC AND MASSAGE, LLC
Entity Type:Organization
Organization Name:LIFEQUEST CHIROPRACTIC AND MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHARF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-659-2000
Mailing Address - Street 1:1050 E RAY RD STE 4-A
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-1777
Mailing Address - Country:US
Mailing Address - Phone:480-659-2000
Mailing Address - Fax:
Practice Address - Street 1:1050 E RAY RD STE 4-A
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-1777
Practice Address - Country:US
Practice Address - Phone:480-659-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7289111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ105056Medicare PIN
AZZ105055Medicare PIN