Provider Demographics
NPI:1538469234
Name:AMERICAN FAMILY CHIROPRACTIC & REHAB AT DESERT RIDGE, LLC
Entity Type:Organization
Organization Name:AMERICAN FAMILY CHIROPRACTIC & REHAB AT DESERT RIDGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-726-2287
Mailing Address - Street 1:1839 S ALMA SCHOOL RD
Mailing Address - Street 2:STE 354
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20830 N TATUM BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-7256
Practice Address - Country:US
Practice Address - Phone:480-563-1144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z143879Medicare UPIN