Provider Demographics
NPI:1497703243
Name:YAVAPAI CHIROPRACTIC ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:YAVAPAI CHIROPRACTIC ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:SANIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-775-8750
Mailing Address - Street 1:3075 N WINDSONG DR
Mailing Address - Street 2:SUITE B1
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-1208
Mailing Address - Country:US
Mailing Address - Phone:928-775-8750
Mailing Address - Fax:928-775-8750
Practice Address - Street 1:3075 N WINDSONG DR
Practice Address - Street 2:SUITE B1
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-1208
Practice Address - Country:US
Practice Address - Phone:928-775-8750
Practice Address - Fax:928-775-8750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty