Provider Demographics
NPI:1568515583
Name:KUKURIN CHIROPRACTIC
Entity Type:Organization
Organization Name:KUKURIN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KUKURIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-547-4727
Mailing Address - Street 1:14327 W MONTE VISTA RD
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-2327
Mailing Address - Country:US
Mailing Address - Phone:623-547-4727
Mailing Address - Fax:
Practice Address - Street 1:12409 W INDIAN SCHOOL RD
Practice Address - Street 2:C304
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-9502
Practice Address - Country:US
Practice Address - Phone:623-547-4727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-21
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7366111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty