Provider Demographics
NPI:1508802422
Name:FIRST CHIROPRACTIC - 22ND ST LLC
Entity Type:Organization
Organization Name:FIRST CHIROPRACTIC - 22ND ST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-886-4213
Mailing Address - Street 1:8560 E 22ND ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-6537
Mailing Address - Country:US
Mailing Address - Phone:520-886-4213
Mailing Address - Fax:520-298-9693
Practice Address - Street 1:8560 E 22ND ST
Practice Address - Street 2:STE. 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6537
Practice Address - Country:US
Practice Address - Phone:520-886-4213
Practice Address - Fax:520-298-9693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ25823Medicare PIN