Provider Demographics
NPI:1508294497
Name:STEWART CHIROPRACTIC AND FAMILY WELLNESS CENTER
Entity Type:Organization
Organization Name:STEWART CHIROPRACTIC AND FAMILY WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BETTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-358-8493
Mailing Address - Street 1:5045 W BASELINE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7393
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5251 W CAMPBELL AVE STE 209
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1719
Practice Address - Country:US
Practice Address - Phone:602-237-1105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEWART CHIROPRACTIC AND FAMILY WELLNESS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7531111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty