Provider Demographics
NPI:1568677268
Name:SCHULTZ CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:SCHULTZ CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-837-5060
Mailing Address - Street 1:16622 E AVENUE OF THE FOUNTAINS
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-8317
Mailing Address - Country:US
Mailing Address - Phone:480-837-5060
Mailing Address - Fax:480-837-3738
Practice Address - Street 1:16622 E AVENUE OF THE FOUNTAINS
Practice Address - Street 2:SUITE 102
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-8317
Practice Address - Country:US
Practice Address - Phone:480-837-5060
Practice Address - Fax:480-837-3738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU56735Medicare UPIN
Z74235Medicare PIN