Provider Demographics
NPI:1568681104
Name:ARIZONA HEALTH CARE CLINIC PC
Entity Type:Organization
Organization Name:ARIZONA HEALTH CARE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:M
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-595-6100
Mailing Address - Street 1:33755 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-1567
Mailing Address - Country:US
Mailing Address - Phone:480-595-6100
Mailing Address - Fax:480-595-6102
Practice Address - Street 1:33755 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-1567
Practice Address - Country:US
Practice Address - Phone:480-595-6100
Practice Address - Fax:480-595-6102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5571111N00000X
AZ3386111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ23355Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER