Provider Demographics
NPI:1467726570
Name:CHANDLER MEDICAL PLLC
Entity Type:Organization
Organization Name:CHANDLER MEDICAL PLLC
Other - Org Name:BACKFIT HEALTH & SPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RADMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHIMINEJAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-926-7800
Mailing Address - Street 1:1450 W. GUADALUPE RD.
Mailing Address - Street 2:#120
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233
Mailing Address - Country:US
Mailing Address - Phone:480-926-7800
Mailing Address - Fax:480-926-2260
Practice Address - Street 1:1949 W. RAY RD
Practice Address - Street 2:#23
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-917-1720
Practice Address - Fax:480-917-6934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare UPIN