Provider Demographics
NPI:1477764868
Name:OCOTILLO CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:OCOTILLO CHIROPRACTIC CENTER PC
Other - Org Name:OCOTILLO CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KILBAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-963-2772
Mailing Address - Street 1:1880 S ALMA SCHOOL RD
Mailing Address - Street 2:STE 1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-2074
Mailing Address - Country:US
Mailing Address - Phone:480-963-2772
Mailing Address - Fax:480-963-3572
Practice Address - Street 1:1880 S ALMA SCHOOL RD
Practice Address - Street 2:STE 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-2074
Practice Address - Country:US
Practice Address - Phone:480-963-2772
Practice Address - Fax:480-963-3572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty